What Is Klumpke’s Palsy?
Klumpke’s palsy, also known as Klumpke’s paralysis or Dejerine-Klumpke palsy, is a condition that occurs from damage to the brachial plexus nerves, which allow for hand and wrist movement and feeling.
Named after the American-born neurologist Augusta Dejerine-Klumpke, Klumpke’s palsy is considered a rare disorder by the National Institutes of Health’s Genetic and Rare Diseases Information Center (GARD).
Approximately one to three infants per 1,000 live births in developed countries suffer a brachial plexus birth trauma.
While anyone may develop Klumpke’s palsy at any age due to accidents and subsequent nerve damage, this nerve trauma most often occurs during labor and delivery.
If your baby went through a difficult delivery and has any sort of arm or hand weakness, consult your doctor as soon as possible for diagnosis and treatment if necessary.
What Is the Brachial Plexus?
Klumpke’s palsy occurs from damage to the nerves in the brachial plexus, which is a collection of nerves that runs from the spinal cord through the armpit, carrying signals to the hand, arm, and shoulder.
Types of injury to this nerve network include:
This is the most common type of brachial plexus injury involving nerve stretching without tearing, often leading to full recovery. It’s caused by compression or reduced blood and oxygen supply, typically linked with inflammation.
The most severe form of Klumpke’s palsy occurs due to the tearing of the nerve from the spinal cord.
Although the nerve is torn, it is not torn from the spinal cord.
Healing has taken place, but the scar tissue does not allow the nerve to receive the proper signaling.
Stretching of the nerves, causing damage.
Klumpke’s Palsy vs Erb’s Palsy
Klumpke’s palsy and Erb’s palsy are both types of brachial plexus palsy.
However, Erb-Duchenne, or Erb’s palsy, affects the upper brachial plexus, while Klumpke’s palsy affects the lower brachial plexus. More specifically, Erb’s palsy affects the shoulder and upper arm, compared to the forearm and hand muscles with Klumpke’s palsy.
In some cases, an infant’s upper and lower nerves are damaged at birth. This condition is known as total plexus involvement, and those affected have trouble moving their shoulders, arms, and hands.
In infants suffering from birth trauma, Erb’s palsy is more common than Klumpke’s palsy.
What Causes Klumpke’s Palsy?
The most common cause of Klumpke’s palsy is traumatic labor and vaginal delivery. This may occur after an obstetrician pulls a baby out of the birth canal by their extended arm, or if the doctor pulls a baby’s neck and head to the side as their shoulders go through the birth canal. Many of these birth injuries are preventable.
Certain risk factors — relating to the mother, the baby, and the delivery itself — increase the likelihood of a baby developing Klumpke’s palsy.
Klumpke’s palsy’s risk factors in expectant mothers include:
- Older age
- Small pelvis/stature
- Pelvic abnormalities
- Gestational diabetes
- Substantial pregnancy weight gain
- A previous birth led to Klumpke’s palsy
Risk factors during labor include:
- Breech births
- Improper forceps use
- Labor induction
- Long-lasting second labor stage
- Overdue pregnancy
- Vaginal birth difficulties
Additionally, a higher-than-average birth weight can be a risk factor for Klumpke’s palsy. The condition occurs more often in Western countries (such as the United States and the United Kingdom), as babies in non-Western countries tend toward lower birth weights, which decreases their risk of Klumpke’s palsy. Further, female infants are less likely than males to develop the condition.
Klumpke’s Palsy Symptoms
Symptoms of Klumpke’s palsy range from minor to severe and may be obvious or relatively subtle. It’s also important to note that the right arm and hand are more likely to be affected by Klumpke’s palsy than the left.
Klumpke’s palsy signs and symptoms include:
- Atrophy of the arm or hand
- Claw hand (flexion of the fingers and wrist)
- Muscle weakness
- Limited range of motion in the arm
- Constant crying due to pain
- Paralysis of the arm or hand
Klumpke’s Palsy Diagnosis
To diagnose Klumpke’s palsy, a medical professional may perform a physical examination and order various tests for a child with arm weakness.
Diagnostic tests for Klumpke’s palsy include:
- Computed tomography (CT scan)
- Electromyogram (EMG)
- Magnetic resonance imaging (MRI)
- Nerve conduction studies
Once a doctor reaches a diagnosis, it is generally most effective for treatment to start right away to avoid potential paralysis or permanent joint and muscle contractions.
Klumpke’s Palsy Prognosis
It’s not uncommon for children with mild Klumpke’s palsy to recover entirely.
“It is estimated that up to 88% of infants recover by 4 months, and 92% by 12 months.”
– Genetic and Rare Diseases Information Center (GARD)
Children with moderate Klumpke’s palsy may experience arm limpness, loss of sensation, joint stiffness, a claw hand, and increased disability and severe pain as they grow.
When substantial nerve damage occurs, such as with avulsion, children may end up completely paralyzed in the shoulders and arms.
Avulsion also puts a child at risk of developing Horner’s Syndrome, which can result in eyelid drooping, small pupils, and inability to sweat on the face (anhidrosis).
Klumpke’s Palsy Treatment Options
Some babies with Klumpke’s palsy will regain normal or near-normal function without treatment.
If X-rays reveal no dislocation or bone breakage, parents should focus on stretching, muscle strengthening, and light exercises to help support the baby’s joints.
These simple therapies can begin just weeks after birth to help prevent the baby’s muscles from atrophying and their joints from stiffening.
If the baby has a severe case of Klumpke’s palsy, surgery may be needed. Tearing or rupturing of the nerves may require procedures such as nerve grafting, in which a healthy nerve is removed from the body and used to repair the damaged nerve.
Another operation is a nerve transfer, which involves replacing the entire damaged nerve with a healthy nerve from the patient.
Additionally, neuromuscular electrical stimulation devices can help improve blood flow while building muscle tissue. As your child grows, they may require ongoing physical therapy to help them maintain strength in the affected hand and arm, depending on the severity of the injury.
Klumpke’s Palsy Compensation
Some cases of Klumpke’s palsy are preventable. For example, various procedures exist to help prevent Klumpke’s palsy during a difficult labor. Among these procedures is a Caesarean section (C-section).
If a pre-labor screening indicates a fetus is too large for a safe vaginal delivery, doctors have a duty to recommend a safer option.
Further, improper use of forceps or a vacuum extractor during a delivery may constitute medical malpractice. In cases of medical malpractice or negligence, the doctor or hospital is allegedly responsible for the child’s injury, and parents and loved ones may be able to file a birth injury claim on their child’s behalf.
If your child suffered a preventable condition like Klumpke’s palsy or cerebral palsy, a birth injury lawsuit may award you with compensation to help pay for costs of care, ongoing therapies, and more.
Get a free case review today if you would like to learn more about accessing compensation.