KLUMPKE PARALYSIS

  •  

    KLUMPKE PARALYSIS

     

    DEFINITION:

    A rare form of brachial palsy due to injury to the C7, C8, and T1 nerves resulting in paralysis and Horner's Syndrome.

    EPIDEMIOLOGY:

    • incidence: ?
    • age of onset:
      • newborn
    • risk factors:
      • birth trauma

    PATHOGENESIS:

    1. Birth Trauma

    • injury to the C7, C8, and T1 -> paralysis
    • injury to the sympathetic fibres of the 1st thoracic root -> Horner's Syndrome

    CLINICAL FEATURES:

    1. Motor

    • paralysis of upper limb, lower limb, and/or hand

    2. Horner's Syndrome

    • ipsilateral ptosis and miosis (anisocoria)
    • apparent enophthalmos with slight elevation of the lower lid
    • may be a decrease in facial sweating
    • increased amplitude of accommodation
    • ocular signs may pass undetected for years in Klumpke's

    3. Complications

    • deltoid muscle atrophy -> shoulder drop

    INVESTIGATIONS:

    1. Imaging Studies

  • 1. MRI/CT Myelography
    • detects nerve root rupture or avulsion
  • MANAGEMENT:

    1. Partial Immobilization and Positioning

    • to prevent the development of contractures

    1. Upper Arm Paralysis

    • abduct arm to 90 degrees, externally rotate shoulder, full suppination of forearm, slight elevation of wrist with palm turned toward the face
    • place in splint or brace intermittently (when asleep, between meals, etc.) for 1-2 weeks

    2. Lower Arm Paralysis

    • splint wrist in the neutral position with padding placed in the fist for 1-2 weeks

    3. Total Arm Paralysis

    • use procedures for both upper and lower arm paralysis

    2. Physiotherapy

    • gentle massage & range of motion exercises started by 7-10 days
    • also active and passive corrective exercises

    3. Surgery

    • indicated if paralysis persists without improvement for 3-6 months
    • neuroplasty, neurolysis, end-to-end anastomosis of nerve ends

    4. Prognosis

    • depends upon the extent of the injury
      • injured (edema, hemorrhage) - return of function in a few months
      • laceration - permanent damage
      • paralysis of the upper arm has a better prognosis than paralysis of the lower arm

     

     

    Pediatric Database - KLUMPKE PARALYSIS

    Pediatric Organization - Pedbase [at] Gmail.com