Klumpke paralysis

Klumpke paralysis is a neuropathy of the lower brachial plexus which may be resulted from a difficult delivery. Usually the eighth cervical and first thoracic nerves are injured either before or after they have joined to form the lower trunk.

Klumpke paralysis is a rare birth defect that affects the nerves of the infant’s shoulder called the brachial plexus. The brachial plexus nerves are responsible for passing message signals from the spinal cord to the shoulder, arms and hands.

The injury is caused when the nerves are compressed, stretched and ripped away from the spinal cord. Such injuries are common in sports like football and basketball.

Some injuries are inborn. Other conditions that cause brachial plexus are tumours and inflammation. When there is a major accident brachial nerves can be damaged in such a way that your arms will be paralysed. In such cases, surgery is recommended and movement can be restored.

Klumpke paralysis that affects the infants may be caused due to complications during the pregnancy.

There are four types of brachial plexus injury that cause Klumpke paralysis according to the  National Institute of Neural Disorders and Stroke (NINDS).

They are avulsion, rupture, neuroma and neuropraxia.

• Avulsion- The condition where the nerve is cut off from the spine.
• Rupture- There is a tear in the nerve but not at the spine.
• Neuroma- The injured nerve has healed but will not be able to transmit signal. This is because the formation of the scar tissue pressurises the nerve.
• Neuropraxia -The nerve is damaged but it is not cut off.

Symptoms

Symptoms of Klumpke paralysis are evident and it causes weakness and numbness in your hands and fingers. A common symptom of Klumpke paralysis is clawed hands.

Limp lower arm, minimal arm, and hand movement

The Klumpke paralysis affects your lower arm, minimal arm and hand movement the most.

Poor reflexes

Klumpke paralysis can cause poor reflexes. Moro reflex is sometimes affected and absent  on the affected side.

Sensory loss

When the C3 and C4 are damaged it causes sensory loss in the lateral side of the upper arm.

Paralysis

The paralysis makes it difficult to lift your arms and you experience a loss of sensation. Paralysis leads to loss of flexion of the elbow and the biceps muscle.

Stiff joints

The function of the joints reduces and becomes stiff. You will feel the difficulty to move around freely.

Pain

You will experience physical pain in Klumpke paralysis. Pain may be caused due to nerve damage and the pain can be chronic.

Muscle weakness and atrophy

Klumpke paralysis causes muscle weakness and atrophy.

Claw hand, tightened hand and fingers

A clawed hand is a condition in which your fingers resemble a bear’s claw. Symptoms like claw hands, tightened hands and fingers can be seen in Klumpke paralysis.

These symptoms can be a congenital defect or may be caused due to injury.

Causes and risk factors

Klumpke paralysis can heal itself. However, some factors increase the risk factor of Klumpke paralysis.

Large birth weight babies

The primary cause of Klumpke paralysis is difficulty during childbirth. When the child is overweight and needs a pull and stretch during childbirth.

This affects the nerve of the baby and can reform as a congenital disease. The labor can be complicated when the baby is overweight.

Maternal diabetes

Maternal diabetes can increase the risk of Klumpke diabetes. Gestational diabetes can have a significant effect on the baby.

Maternal diabetes increases the risk of Klumpke diabetes.

Multiparity

Multiparity is a condition of women during their fertile age giving birth more than twice. Multiparity increases the risk of nerve damage and can cause multiparity.

Shoulder dystocia

During labor, the baby’s shoulder can get stuck in the birth canal. This can damage the arms of the baby.

Forceps or vacuum delivery

Complications can occur during labor and forceps or vacuum can be used in the second stage of labor. These are used to assist the baby through the birth canal.

When forceps are used to direct the baby towards the birth canal it can affect the arms and bones. This type of delivery can increase the risk of Klumpke paralysis.

Breech position

Breech position is the position of the baby’s leg coming out first during labor. The baby’s shoulder can get wedged during the labor and this increases the risk of Klumpke paralysis.

Prolonged labor

When the second stage of labor persists for more than an hour, it can increase the risk factor of Klumpke paralysis.

Previous child with obstetric palsy

Obstetric palsy is an injury caused during birth. It damages the brachial plexus as a result the arm hangs vertically still attached to the spine. However, the paralysis caused by obstetric palsy will be flabby.

The risk factor of getting affected by Klumpke paralysis increases when the previous baby had a history of obstetric palsy.

Intrauterine torticollis

Torticollis is a condition of abnormal head or neck position. The head gets tilted to one side and the chin to the other side.

These complications are common during birth and they can be acquired too. There are chances of a wry neck getting healed on  itself. The damage to the nerve near the neck can cause Klumpke paralysis.

Less common includes tumours (neuromas, rhabdoid tumours),

The rhabdoid tumour occurs in the brain, kidneys and other soft tissues. These tumours grow in mass as large cells. These tumours can paralyse the arms.

Intrauterine compression, hemangioma and exostosis of the first rib in the child

Klumpke paralysis can be either a complete brachial plexus, trunk brachial plexus or bilateral brachial palsy.

The cause and the degree of injury determine the prognosis of the disease.

Diagnosis

The diagnosis of Klumpke paralysis is always diagnosed during the time of birth.

Electromyogram (EMG)

The electromyogram is an electrodiagnostic study. The electromyogram helps to determine the electrical activity between the muscles in response to the stimulus. The test also determines the speed at which electrical impulses are conducted.

The electromyogram helps to confirm the nerve damage and its severity. The test is performed  by using a needle. The needle is a recording electrode and is placed on the skin and into the muscle.

The needle records the electrical activity by measuring the motor unit action potential (MUAP). The device produces a graph of electrical activity and records the result.

Imaging studies

The imaging study is further used to point to the location of the injury. The imaging study can be either an X-ray, MRI, ultrasound or other imaging methods. The imaging techniques identify the damaged nerve and bones.

Nerve conduction studies

 The skin electrodes are connected together. One electrode stimulates the signal and the other records the response. The study is further divided into the motor and sensory tests. These tests will confirm the damage and severity of the sensory and motor components.

Conclusion

Klumpke paralysis causes pain and burning sensation. Medications are recommended to mitigate the burning sensation.

Infants with Klumpke paralysis usually heal in six months. In cases like where the nerve tearing occurs the symptoms may last for years.

If the paralysis does not heal in a period of six months surgery will be recommended. Patients with Klumpke paralysis will recover and bounce back with normal strength and movement. In rare cases, people have lifetime disabilities.

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