Klumpke Paralysis in Newborns - A Parent’s Guide

What Is Klumpke Paralysis? Signs, Diagnosis & Care Options

Klumpke paralysis is a neurological injury affecting the lower brachial plexus nerves. These nerves control movement and sensation in the hands, fingers and wrists. Babies weighing more than the average are more likely to develop this condition. Doctors determine treatment according to the type and severity of the injury. It shares symptoms with many conditions, Erb's palsy being the most common.

Introduction

Named after neurologist Augusta Dejerine-Klumpke, it is a birth injury affecting hand and wrist movement. It usually occurs due to nerve damage in newborn babies caused by difficult labour and delivery. Although it is a rare condition, it can result in permanent paralysis if not treated.

In this blog, we will dive deeper into this birth injury and discuss its causes, symptoms and treatment options.

What is Klumpke's paralysis?

This injury primarily affects the brachial plexus nerves. These nerves originate from the cervical spinal cord and control motor and sensory functions in the arms. Anatomically, they run down the side of the neck, passing the armpit to the arm.

Doctors refer to this brachial plexus damage as Klumpke’s palsy or paralysis.

What are the risk factors?

Pregnant women who can give birth to newborns with brachial plexus injury are as follows:

• Women with pelvic floor abnormalities
• Gestational diabetic women
• Women having a small stature or pelvis
• Older pregnant women
• Pregnancy weight gain
   

However, these are not all. Klumpke paralysis can also be a result of improper handling during delivery. Additionally, some labour complications may also cause this. They are:

• Overdue pregnancy
• Improper use of forceps
• Breech birth
• Difficulties during vaginal birth
• Longer than usual second labour stage
• Labour induction
   

In newborns, a higher-than-average birth weight can also result in this injury. A normal, healthy birth weight ranges from 2.5 kg to 4 kg. If your baby’s weight is more than that, there is a possible risk of Klumpke's paralysis.

What Injuries Cause Klumpke Paralysis?

Since the condition primarily affects the brachial plexus nerves, the type and degree of injury are important. Doctors classify the injury into 4 types. They are as follows:

• Neuropraxia: This is a mild injury where the nerves stretch without tearing. Reduced blood and oxygen supply may cause it.
• Neuroma: In this, the nerves have scars on them, preventing proper signalling.
• Rupture: This is a severe form of injury where the nerves tear in place, although they are still attached to the spinal cord.
• Avulsion: The most severe form of injury is avulsion. In this, the nerves tear away from the spinal cord. It can lead to permanent paralysis of the hand.
   

What are the Signs of Klumpke Paralysis?

If your newborn baby develops Klumpke palsy, you may notice a plethora of symptoms. Therefore, knowing them can help you identify and seek help immediately. These symptoms are:

• Intrinsic minus hand
• Wrist flexor weakness.
• No or minimal hand and arm movement
• Your baby exhibits poor reflexes and hand weakness.
• Pain in the arm
• Stiff joints
• Sensory loss
   

If you notice any of these symptoms, immediately consult a doctor. The sooner you seek help, the better for your baby.

Comparative Analysis: Erb’s vs. Klumpke

People often confuse Klumpke paralysis with Erb’s paralysis. While both are brachial plexus injuries, they differ slightly. Let us discuss the differences in the table below:

Therefore, these two injuries mainly differ in the areas affected by them. However, both can cause paralysis if not treated.

Differential Diagnosis of Klumpke Paralysis

Differential diagnosis refers to other conditions exhibiting similar symptoms. It can lead to doctors misidentifying a condition. Klumpke paralysis, too, shares symptoms with other injuries. These include:

• Shoulder impingement
• Thoracic outlet syndrome
• Erb’s palsy
• Disc herniation
• Clavicular or vertebral fracture
• Distal ulnar nerve entrapment
• Apical lung tumour
• Neurofibroma
   

How Do Doctors Diagnose This Condition?

Doctors may start with a physical examination and order multiple tests to establish a diagnosis. Tests such as computed tomography (CT scan), nerve conduction studies, magnetic resonance imaging (MRI), and ultrasound confirm the diagnosis. Additionally, doctors may use electromyography (EMG) for further information.

Once a doctor diagnoses Klumpke paralysis, you should immediately start treatment for a faster recovery.

What are the treatment options?

Healthcare professionals may suggest non-surgical and surgical treatment options. Generally, newborn babies often suffer from some damage during birth. These usually heal after 3-4 months. However, some might not heal and can cause future problems.

Doctors recommend physical therapy for mild brachial plexus nerve damage. Motion movements, gentle massage and joint mobilisation help to heal the damage.

Other non-surgical treatment options include:

• Neuromuscular electrical stimulation
• Aquatic therapy
   

However, if the baby has sustained severe injuries such as rupture or avulsion, surgery may be necessary.

• Nerve Transfer: Doctors use a nearby nerve and connect it to the brachial plexus network. This procedure is more durable and more likely to bring back movement and sensation in the arm.
• Nerve Graft: In this process, doctors take a nerve from the patient’s body and graft it to bypass the damaged nerve. This promotes healing and is only used in case of severe injury.
• Muscle Transfer: If the baby's treatment gets delayed beyond 12 months, doctors use this surgical intervention. In this, doctors sever and reconnect muscle tissues to promote movement and sensation.
   

Living With Klumpke: What to Expect?

Unlike popular belief, Klumpke paralysis is not life-threatening. Most babies with mild damage recover totally within 6 months to 1 year.

However, more severe forms of damage may be lifelong. It results in the inability to sweat on the face, small pupils and drooping of the eyelid.

Final Thoughts

Learning that your baby has nerve damage can be scary. But do not panic; the faster you start treatment, the better. Many times, Klumpke's paralysis is caused by neglect and improper handling during birth. If you feel like your birth care team mishandled you, consult a birth injury lawyer.

With proper care and prevention techniques, this condition can be avoided. Stay strong and seek immediate help if you notice any symptoms in your baby.