Klumpke’s palsy, or Klumpke's paralysis, is a form of brachial plexus palsy – a paralysis of the arm due to an injury of the network of spinal nerves that originates in the back of the neck, extends through the shoulder and armpit and gives rise to nerves in the arm. Klumpke's palsy is also sometimes referred to as Dejerine-Klumpke palsy.

In Klumpke’s palsy, the muscles of the forearm, wrist and hand are most affected. It is caused by a birth injury to the neck and shoulder due to a difficult vaginal delivery, tumor of the lung or shoulder, or trauma to the arm and shoulder. The nerves may be stretched or torn, causing weakness, pain or numbness.

Baptist Health is known for advanced, superior care in diagnosing and treating Klumpke’s palsy. Our 24/7 inpatient neurology and neurosurgery services, as well as our outpatient services, Home Health, physical and occupational therapy services are available to help treat people with Klumpke’s palsy.

You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Klumpke’s palsy symptoms include:

• Atrophy in the muscles of the forearm or hand
• “Claw hand,” a severe symptom in which the forearm lies flat but the wrist and fingers are tightened
• Horner’s syndrome – drooping of the eyelid on one side of the face
• Inability to use the muscles of the affected arm and/or hand
• Limp or paralyzed arm
• Numbness of the affected arm and/or hand
• Pain, sometimes severe
• Stiff joints in the wrist and hand
• Weakness of the affected arm and/or hand

Diagnosis

To determine if a patient has Klumpke’s palsy, a healthcare provider will perform a physical examination to evaluate arm and hand weakness and other symptoms. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures may include:

Electromyogram (EMG): This test measures the electrical activity of a muscle in response to stimulation, as well as the nature and speed of the conduction of electrical impulses along a nerve. It can confirm the presence of nerve damage and assess its severity.

Imaging studies: The physician may order an X-ray, ultrasound, MRI or other imaging test to check for damage to bones and joints of the neck and shoulder.

Nerve conduction studies: These tests measure how well individual nerves can send an electrical signal from the spinal cord to the muscles. A physician places a stimulating electrode directly over the nerve to be studied, and a recording electrode over the muscles supplied by that nerve. The shock-emitting electrode sends repeated, brief electrical pulses to the nerve, and the recording electrode records the time it takes for the muscle to contract in response to the electrical pulse.

Causes

Klumpke’s palsy can be caused by a difficult childbirth. It usually occurs during vaginal deliveries, especially in cases where the mother is small and the baby has a large birth weight. Large birth weight in a baby can occur due to poorly managed maternal diabetes or gestational diabetes. This birth injury sometimes occurs when the baby is pulled from the birth canal by an extended arm above the baby’s head. If done too roughly, this can injure the lower brachial plexus. Injuries are similar to those that occur in Erb’s palsy.

Klumpke’s palsy can also be caused by tumors in the area of the upper lung and collarbone which compress or stretch the nerves to the arm. It can also be caused by trauma to the arm and shoulder, such as force to the arm or shoulder when catching oneself during a fall.

Risk Factors

Risk factors that may contribute to Klumpke’s palsy include:

• Breech birth: Babies born feet-first are at a slightly higher risk of Klumpke’s palsy because their arms may be raised and more easily injured from excess pressure.
• Gestational diabetes: If blood sugar is not well-managed, babies may be born larger, making delivery more difficult.
• Improper delivery/ use of birthing tools: During a complicated delivery, a baby may be pulled quickly and forcibly from the birth canal, causing injury to the neck and shoulder.
• Large infant/small maternal size: Delivery may be more difficult if the infant is larger than normal or the mother is particularly petite.
• Second stage of labor lasting over an hour: A long-lasting “pushing” stage may put an infant at a greater risk of Klumpke’s palsy and other brachial plexus injuries.
• Injury: Trauma to the arm or shoulder can cause Klumpke’s palsy.
• Cancer: A history of cancer or risk factors for cancer can increase the risk of Klumpke’s palsy.

Prevention

The risk of Klumpke’s palsy can be minimized by:

Advanced planning: If the baby is larger than usual or in the incorrect position in the weeks leading up to the due date, advanced planning by the obstetrician to prevent Klumpke’s palsy should include insuring qualified personnel are present in the delivery room, proper use of birthing instruments and extractors, and induction of labor or Cesarean delivery if several risk factors are identified.

Maternal healthcare: Good maternal healthcare during pregnancy, including avoidance or control of diabetes, can help prevent Klumpke’s palsy.

Prognosis

In most cases, a baby will recover from Klumpke’s palsy within six months. In more severe cases, in which there is tearing of the nerve(s) – especially away from the spine – symptoms may last for years or children may experience lifelong disabilities of the arm, hand or fingers.

Treatment and Recovery

Treatment of Klumpke’s palsy may include:

Non-Surgical Treatments

• Physical therapy: Daily physical therapy is effective in treating mild Klumpke’s palsy. Your physician or physical therapist will show you which therapeutic and range-of-motion exercises you must perform to promote healing and prevent joint stiffening in the elbow, wrist and hand.
• Medications: Klumpke’s palsy often causes pain or a burning sensation. Physicians often prescribe medications to relieve this mild Klumpke's palsy pain, including topical ointments and prescription medications.

Surgical Procedures
If physical therapy doesn’t show promising results after three to six months, your physician may recommend surgery to repair injury to the affected nerves. This may include:

• Muscle transfer: A less important muscle or tendon can be removed from another part of the body and attached to the affected arm if the muscles there deteriorate.
• Nerve graft: Some nerve ruptures can be repaired by splicing a “donor” nerve graft from a separate nerve.
• Nerve transfer: In some cases, a surgeon can transfer a nerve from a different muscle to restore function in the nerve.    
• Recovery: Because nerves recover very slowly, it may take months to years for nerves repaired at the neck to reach the muscles of the lower arm and hand. After surgery, you will need to perform rehabilitation exercises at home to improve your baby’s strength and range of motion.  

Complications

Most patients with Klumpke’s palsy will recover strength, feeling and movement in the affected arm. Rarely, patients will experience lifelong disabilities of the arm, hand or fingers.