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Klumpke’s Palsy

Klumpke’s palsy is a severe medical condition caused by nerve damage that affects the wrist and hand. The National Institute for Neurological Disorders and Stroke notes that the characteristics of  Klumpke’s palsy include paralysis of the lower brachial plexus as opposed to Erb’s palsy, which refers to the “paralysis of the upper brachial plexus.”

Higher birth weight is one of the condition’s risk factors, making it less common in Eastern countries. But a higher birth weight isn’t the only risk factor. Any baby has the potential to suffer a birth injury such as Klumpke’s palsy.

In some cases, people develop this condition later in life due to accidents or injuries damaging their nerves. However, the majority of Klumpke’s palsy cases occur at birth. Understanding what causes these cases lowers the chances of complications for the mother and the child alike.

What causes Klumpke’s palsy?

Klumpke’s palsy, also called Klumpke’s paralysis or Dejerine-Klumpke palsy, typically comes from a brachial plexus injury or birth trauma. NINDS states that “many brachial plexus injuries happen when a baby’s shoulders become impacted during delivery and the brachial plexus nerves stretch or tear.”

The brachial plexus is a collection of nerves running from the spinal cord and through the armpit. This crucial part of the nervous system carries signals from the brain to the shoulder, arm, and hand. Parents who notice problems with their newborn’s arm, wrist, or hand should immediately consult their doctor for a brachial plexus palsy diagnosis and any necessary treatment.

There are several different types of injuries to the brachial plexus that can cause Klumpke’s palsy, including:

Avulsion

a severe form of Klumpke’s palsy where something tears the nerves away from the spinal cord.

Neuropraxia

the most common type of brachial plexus injury that causes Klumpke’s palsy, in which the nerve is stretched but not torn.

Neuroma

an injury that has healed, but the scar tissue stops the nerve signals from reaching their proper destination.

Rupture

a nerve is torn but not torn away from the spinal cord.

While these injuries can be serious, some cause more long-term disruption than others. The injury’s severity affects the available treatment options and the long-term prognosis for the affected child.

Lower brachial plexus injuries often occur when the child exits the birth canal. This is more common with breech babies and other difficult births but can happen during any delivery. In some cases, a doctor may recommend a Cesarean section (c-section) to reduce the chances of trauma to the baby in or upon exiting the birth canal.

Klumpke’s risk factors can appear during pregnancy, labor, or delivery. Careful physicians can control some aspects, but some elements are unchangeable, such as the mother’s physical characteristics.

Palsy is more common in mothers who have:

  • Pelvic abnormalities
  • A small size
  • An older age
  • Substantial weight gain during pregnancy
  • Gestational diabetes
  • Previously given birth to a baby affected by Klumpke’s palsy

However, it’s not just maternal conditions that affect the likelihood of their child developing this condition. Some of the actual labor and delivery risk factors are:

  • Labor induction
  • Breech birth
  • Carrying past the due date
  • Difficulties during vaginal birth
  • Improper use of forceps
  • Protracted second stage of labor

Any of those can increase the risk of contracting Klumpke’s palsy, and having multiple risk factors compound the likelihood. Babies born heavier than average and male babies also carry a greater risk of developing the condition.

Signs and symptoms of Klumpke’s palsy

The main symptom of Klumpke’s palsy is weakness in the hand, arm, and wrist, potentially resulting in “claw hand” and other identifying characteristics. The symptoms can be subtle or obvious depending on the injury’s severity.

According to the authors of Syndromes: Rapid Recognition and Perioperative Implications, obstetric brachial plexus palsy affects the right side more often than the left, but both sides are susceptible. Among the most common signs are:

  • “Claw hand” (the hand curls in on itself, similar to a claw)
  • Muscle weakness
  • Limited range of arm motion
  • Arm or hand paralysis
  • Arm or hand atrophy
  • Crying from pain or discomfort

If a newborn is experiencing any of these issues, a physician must examine the affected arm and brachial plexus nerves to determine the issue’s seriousness. Determining the extent of the damage is the first step toward a treatment plan.

How is Klumpke’s palsy diagnosed?

The first step toward diagnosing Klumpke’s palsy is a physical exam, which gives the doctor insight into the arm’s weakness, range of motion, and other factors contributing to a diagnosis.

Tests for Klumpke’s palsy include X-rays, electromyography (EMG), ultrasounds, and nerve conduction studies. Doctors generally don’t start treatment before diagnosing because an ineffective treatment plan could cause additional harm. But once the physician diagnoses the condition, immediate treatment can give the child the best chance of recovery.

What is the difference between Erb’s palsy and Klumpke’s palsy?

Erb’s palsy and Klumpke’s palsy are both brachial plexus injuries. Erb-Duchenne, or Erb’s palsy, affects the upper brachial plexus, impacting the shoulder and upper arm, whereas Klumpke’s palsy affects the lower brachial plexus, affecting the use of the hand and wrist.

Both injuries can reduce the arms’ range of motion and atrophy the hand or limb due to loss of use. In rare cases, both types of palsy occur in newborns, involving the entire plexus and causing problems with the shoulders, arms, and hands.

What is the treatment for Klumpke’s palsy?

Klumpke’s palsy’s treatment options depend on its severity. In some babies, near-normal or normal movement comes back on its own. If there are no broken bones or joint dislocation, treatment should focus on support, stretching, and muscle strengthening through light exercise.

Severe cases, however, may require surgery. Nerve gathering, nerve grafting, and related options allow a doctor to take healthy nerves from elsewhere in the body and use them to restore feeling and range of motion to the infant’s affected arm.

Avulsions and ruptures require repair or replacement of the damaged nerve so the infant can develop normally and avoid atrophy and paralysis. Doctors often use neuromuscular electrical stimulation devices to improve blood flow to the area and aid muscle building.

Children born with palsy may need ongoing physical therapy to maintain strength in the lower and upper limb and retain as much range of motion as possible. The cervical nerves do some healing on their own, but serious cases of nerve injury require neurosurgery for the best chance of recovery.

The hand and forearm muscles need stimulation and use to stay strong. If paralysis occurs, those muscles will atrophy quickly. There are ways to reduce the chances of obstetric brachial plexus palsy, but it can still occur in some babies. Starting treatment quickly provides the best opportunity for improvement.

What is the prognosis for Klumpke's palsy?

In mild cases of Klumpke’s palsy, a baby can recover a normal range of motion and feeling in a few months. Fortunately, that’s the case for many babies born with this condition. However, more severe cases that have deep damage to the nerve roots or tearing of the nerve are different.

Babies who have damage to the ulnar nerve where it meets the spinal column or have had the nerves torn away from the spine may never recover fully. There may always be some hand or arm weakness, and some may experience lifelong full or partial paralysis. Flexors shorten over time, and shoulder dystocia may occur.

Additionally, anyone who experiences Klumpke’s palsy due to tumors or a lesion may not have the ability to restore or improve range of motion. Because nerve injuries can range in severity and often have different causes, their prognosis varies from patient to patient.

Parents who notice any hand or arm weakness in their newborn child should see their pediatrician as soon as possible. Running tests and documenting symptoms starts the process of determining the problem’s cause, treatment, and prognosis.