Klumpke Pasly Brendon and Blessing Group 5 Final[1]

Klumpke’s Palsy
Blessings Longadi Tzm/11500

Brendon Jambaya Tzm/11518
Group 5
Moderator: Dr Mwaanga
Introduction
• Klumpke’s palsy, named after Augusta Dejerine-Klumpke is a
neuropathological condition.
• This occurs due to injury to nerves of the lower trunk (C8 and T1)
of the brachial plexus.
• Causes weakness or paralysis in the hand, wrist, and forearm.
• Commonly affected nerves: radial, median and ulnar.
• The brachial plexus is a bundle of individual nerves that exit
between the anterior and middle scalene muscles in the anterior
lateral and basal portion of the neck.
Relevant Anatomy
Relevant Anatomy
Relevant Anatomy
Relevant Anatomy
Epidemiology
• Klumpke’s palsy is a rare injury, often associated with traumatic birth events.
• The incidence is estimated at about 0.2 to 4.6 per 1,000 live births.
• Much rarer in adults, typically resulting from trauma (e.g., falls, motor vehicle
accidents) or tumor compression of the brachial plexus.
• The incidence of Klumpke’s palsy is estimated at around 0.12% of all births via
cesarean section.
• The incidence is found to be higher with macrosomic and twin pregnancies.
• No clear gender predisposition, although some studies suggest a higher
frequency in males due to their larger birth size.
Risk Factors
• Shoulder dystocia
• Large birth weight babies (macrosomia)
• Maternal diabetes
• Multi-parity
• Forceps or vacuum delivery
• Breech position
• Prolonged labor
• Intrauterine torticollis
Etiology
• Birth injury to the neck and shoulder due to difficult vaginal delivery.
• Shoulder dystocia
• Hyper-abduction trauma to the arm with enough intensity to traction the lower
brachial plexus.
• Rupture, tearing of nerves in place
• Avulsion, a tearing of the nerves away from the spine
• Tumors proximal to the region may also be a factor (Pancoast tumor)
Pathophysiology
• Injury to the lower brachial plexus (C8-T1)
• Disruption of nerve signals between the spinal cord and the
hand and forearm
• Neurapraxia
• Axonotmesis
• Neurotmesis
• Weakness or paralysis of the muscles of the hand and forearm
• Loss of sensation
Mechanisms of nerve injury
• Compression: Pressure leading to ischemia and conduction
block.
• Traction (Stretch): Overstretching causing axonal or complete
nerve disruption.
• Laceration: Sharp cuts causing complete nerve severance.
Clinical Presentation
SYMPTOMS SIGNS
• Numbness (C8/T1 Dermatome) • Atrophy of affected muscles e.g.
• Pain which can be sometimes forearm
severe • Claw hand with a flexed wrist
• Stiff joints in wrist and arm and phalanges.
• Muscle weakness or paralysis
• Drooping of the eyelid
• Constriction of the pupil
• Horner’s Syndrome
• Tenderness
Clinical Presentation
Investigations
• Electromyography (EMG), helpful for evaluating
nerve function, localizing the lesion and checking
for severity of injury).
• EMG measures the electrical activity of a muscle
in response to stimulation, it tells you the nature
and speed of conduction of the nerve.
Investigations
• Ultrasound:
• Vascular studies with ultrasound to confirm normal blood flow to the
affected limb.
• It can identify nerve root avulsion, neuroma formation, or signs of nerve
thickening or edema.
• Can help assess muscle atrophy and nerve healing
• Magnetic Resonance Imaging:
• Visualizing brachial plexus and detecting injuries, tumors or structural
anomalies
• X-rays:
• Bone injury assessment
Differential Diagnosis
• Erb’s palsy
• Cervical reticulopathy
• Distal ulnar nerve entrapment
• Thoracic outlet syndrome
• Neurofibroma
• Apical lung tumor
• Shoulder impingement
• Clavicular or vertebral fracture
Differential Diagnosis
Treatment
Non-surgical treatment
Pain Management
• Over the counter pain relievers ( e.g Non-steroidal anti-inflammatory
drugs for mild pain)
• Prescription medications (e.g Gabapentin for severe pain)
Physical Therapy
• Daily physical therapy is effective in treating mild klumpke’s palsy.
Orthotic devices
• Splints or braces may be used to support the arm and hand, helping to
maintain function
TREATMENT
SURGICAL PROCEDURES
• Physicians will result to surgical procedures if physical therapy is not proving to be
promising after three to six months. This may include:
Muscle Transfer
• This is where a less important muscle or tendon from another part of the body is
attached to the affected arm if there is muscle deterioration.
Nerve graft
• Rupture of nerve can be repaired by splicing a “donor” nerve from a different
muscle to restore function of the nerve.
Nerve transfer
• A surgeon can transfer a nerve from a different muscle to restore function in the
nerve.
Complications
• Motor Complications:
• Permanent Weakness or Paralysis of the Hand and Forearm:
• Claw Hand Deformity
• Atrophy of Hand and Forearm Muscles
• Sensory Complications:
• Permanent Sensory Loss
• Increased Risk of Injury
• Functional Limitations:
• Loss of Fine Motor Skills
• Decreased Hand Strength
• Limited Range of Motion
Complications
• Deformities and Contractures:
• Contractures of the Fingers and Wrist
• Shoulder Deformities
• Psychosocial Complications:
• Developmental Delays in Children
• Emotional and Social Impact
• Horner’s Syndrome (Severe Cases)
• Failure of Nerve Regeneration
• Chronic Pain and Neuropathic Pain
References
• Ulgen BO, Brumblay H, Yang LJ, Doyle SM, Chung KC. Augusta Déjerine-Klumpke,
M.D. (1859-1927): a historical perspective on Klumpke's palsy. Neurosurgery.
2008 Aug;63(2):359-66; discussion 366-7.
• Harry WG, Bennett JD, Guha SC. Scalene muscles and the brachial plexus:
anatomical variations and their clinical significance. Clin Anat. 1997;10(4):250-2.
• Sunderland S. The anatomy and physiology of nerve injury. Muscle Nerve.
1990;13(9):771-84.
• Ulrich D, van Rensburg M, Dedual M. Cervical nerve root avulsion and brachial
plexus injury: a clinical and electromyographical study. J Bone Joint Surg Br.
1993;75(1):50-4.

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Klumpke’s Palsy

Blessings Longadi Tzm/11500

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