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The injury can result from difficulties in [[childbirth]]. The most common aetiological mechanism is caused by a traumatic vaginal delivery, necessitated by [[shoulder dystocia]]. The risk is greater when the mother is small or when the infant is of large weight. Risk of injury to the lower brachial plexus results from traction on an abducted arm, as with an infant being pulled from the birth canal by an extended arm above the head or with someone catching himself by a branch as he falls from a tree. Lower brachial plexus injuries should be distinguished from upper brachial plexus injuries, which can also result from birth trauma but give a different syndrome of weakness known as [[Erb's palsy]].
The injury can result from difficulties in [[childbirth]]. The most common aetiological mechanism is caused by a traumatic vaginal delivery, necessitated by [[shoulder dystocia]]. The risk is greater when the mother is small or when the infant is of large weight. Risk of injury to the lower brachial plexus results from traction on an abducted arm, as with an infant being pulled from the birth canal by an extended arm above the head or with someone catching himself by a branch as he falls from a tree. Lower brachial plexus injuries should be distinguished from upper brachial plexus injuries, which can also result from birth trauma but give a different syndrome of weakness known as [[Erb's palsy]].


An easy way to remember Klumpke paralysis (or Klumpke's Palsy) is by remembering the phrase "Klumpke the monkey hung from a tree", as a cause of injury is catching oneself on a tree branch when falling.
An easy way to remember Klumpke paralysis (or Klumpke's palsy) is by remembering the phrase "Klumpke the monkey hung from a tree", as a cause of injury is catching oneself on a tree branch when falling.


==Symptoms==
==Symptoms==

Revision as of 11:54, 15 March 2013

Klumpke paralysis
SpecialtyPediatrics Edit this on Wikidata

Klumpke's paralysis (or Klumpke's palsy or Dejerine-Klumpke palsy) is a variety of partial palsy of the lower roots of the brachial plexus.[1][2] The brachial plexus is a network of spinal nerves that originates in the back of the neck, extends through the axilla (armpit), and gives rise to nerves to the upper limb.[3][4][5][6] (see picture - click to enlarge). It is named after Augusta Déjerine-Klumpke.[7][8][9]

Cause

Klumpke's paralysis is a form of paralysis involving the muscles of the forearm and hand, resulting from a brachial plexus injury in which the eighth cervical (C8) and first thoracic (T1) nerves are injured either before or after they have joined to form the lower trunk. The subsequent paralysis affects, principally, the intrinsic muscles of the hand (notably the interossei, thenar and hypothenar muscles)[10] and the flexors of the wrist and fingers (notably flexor carpi ulnaris and ulnar half of the flexor digitorum profundus).[1][6][10][11] Forearm pronators and wrist flexors may be involved, as may dilators of the iris and elevators of the eyelid (both of which may be seen in the case of associated Horner's Syndrome). The classic presentation of Klumpke's palsy is the “claw hand” where the forearm is supinated and the wrist and fingers are flexed. If Horner syndrome is present, there is miosis (constriction of the pupils) in the affected eye.

The injury can result from difficulties in childbirth. The most common aetiological mechanism is caused by a traumatic vaginal delivery, necessitated by shoulder dystocia. The risk is greater when the mother is small or when the infant is of large weight. Risk of injury to the lower brachial plexus results from traction on an abducted arm, as with an infant being pulled from the birth canal by an extended arm above the head or with someone catching himself by a branch as he falls from a tree. Lower brachial plexus injuries should be distinguished from upper brachial plexus injuries, which can also result from birth trauma but give a different syndrome of weakness known as Erb's palsy.

An easy way to remember Klumpke paralysis (or Klumpke's palsy) is by remembering the phrase "Klumpke the monkey hung from a tree", as a cause of injury is catching oneself on a tree branch when falling.

Symptoms

Symptoms include claw hand, paralysis of intrinsic hand muscles, and ulnar nerve distribution numbness. Involvement of T1 may result in Horner's syndrome, with ptosis, and miosis.[1][12][13]

It can be contrasted to Erb-Duchenne's palsy, which affects C5 and C6.

Incidence/prevalence

Klumpke Palsy is listed as a 'rare disease' by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH). This means that Klumpke Palsy, or a subtype of Klumpke Palsy, affects fewer than 200,000 people in the US population.

See also

References

  1. ^ a b c Warwick, R., & Williams, P.L, ed. (1973). Gray’s Anatomy (35th ed.). London: Longman.{{cite book}}: CS1 maint: multiple names: editors list (link) p.1046
  2. ^ Shoja MM, Tubbs RS (2007). "Augusta Déjerine-Klumpke: the first female neuroanatomist". Clin Anat. 20 (6): 585–7. doi:10.1002/ca.20474. PMID 17330887. {{cite journal}}: Unknown parameter |month= ignored (help)
  3. ^ Warwick, R., & Williams, P.L. (1973). pp.1037-1047
  4. ^ Tortora, G.J., & Anagnostakos, N.P. (1990). Principles of Anatomy and Physiology (6th ed.). New York: Harper & Row. ISBN 0-06-046694-4.{{cite book}}: CS1 maint: multiple names: authors list (link) pp.370-374
  5. ^ Abrahams, P (2002). The Atlas of the Human Body: A Complete Guide to How the Body Works. Leicester, U.K.: Silverdale Books. ISBN 1-85605-699-6. pp.76-77
  6. ^ a b Shenaq S.M., & Spiegel A.J. Hand, Brachial Plexus Surgery. eMedicine.com. URL: http://www.emedicine.com/plastic/topic450.htm. Accessed on: April 13, 2007.
  7. ^ Ulgen BO, Brumblay H, Yang LJ, Doyle SM, Chung KC (2008). "Augusta Déjerine-Klumpke, M.D. (1859-1927): a historical perspective on Klumpke's palsy". Neurosurgery. 63 (2): 359–66, discussion 366–7. doi:10.1227/01.+NEU.0000320420.25035.A7. PMID 18797367. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  8. ^ synd/335 at Who Named It?
  9. ^ A. Dejerine-Klumpke: Contribution à l’étude des paralysies radiculaires du plexus brachial. Paralysies radiculaires totales. Paralysies radiculaires inférieures. De la participation des filets sympathiques oculo-pupillaires dans ces paralysies. Revue de médecine 1885, 5: 591-616, 739-90.
  10. ^ a b Page 512: Lower Radicular Syndrome (Klumpke Paralysis) in: Pedley, Timothy A.; Rowland, Lewis P.; Merritt, Hiram Houston (2010). Merritt's neurology. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-9186-3.{{cite book}}: CS1 maint: multiple names: authors list (link)
  11. ^ Klumpke palsy. Stedman's Dictionary. URL: http://www.emedicine.com/asp/dictionary.asp?exact=Y&keyword=Klumpke+palsy. Accessed on: April 13, 2007.
  12. ^ Huang YG, Chen L, Gu YD, Yu GR (2008). "Histopathological basis of Horner's syndrome in obstetric brachial plexus palsy differs from that in adult brachial plexus injury". Muscle Nerve. 37 (5): 632–7. doi:10.1002/mus.20960. PMID 18236458. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  13. ^ Mosby's Medical, Nursing, and Allied Health Dictionary (3rd ed.). St. Louis, Missouri: The C.V. Mosby Co. 1990. ISBN 0-8016-3227-7. {{cite book}}: Unknown parameter |editors= ignored (|editor= suggested) (help) pp.576, 667
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