Klumpke’s Palsy Flashcards
Klumpke palsy, named after
Augusta Dejerine-Klumpke
a neuropathy involving the
lower brachial plexus
The brachial plexus is a bundle of individual nerves that exit between the __________and ____________ muscles in the _________ and ____________ of the neck.
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.
Etiology of klumpke’s paralysis
The most common etiology resulting in Klumpke palsy is a hyper-abduction trauma to the arm that has enough intensity to traction the lower brachial plexus. Trauma during birth can cause brachial plexus injuries, but again hyper-abduction and traction forces to the upper extremity are usually present. A compression injury has similar signs and symptoms, for example, an apical lung tumor gets to a size where it presses on the cervical sympathetic ganglia or C8 to T1 nerve root. If there is a sympathetic involvement, Horner syndrome may present.[5] Approximately 50% of all brachial plexus injuries happen between the age of 19 to 34.[
,if the neurological damage has led to muscular atrophy and tightening, the patient may present with a “________hand.”
if the neurological damage has led to muscular atrophy and tightening, the patient may present with a “claw hand.”
Claw hand
This deformity presents a finger and wrist flexion. The patient may also describe the severe pain that starts at the neck and travels down the medial portion of the arm. One other sign of a lower brachial plexus injury is Horner syndrome; because of its approximation to the T1 nerve root, it may damage the cephalic sympathetic chain. If this happens, the patient will develop ipsilateral ptosis, anhidrosis, and miosis
Because of its location, Klumpke palsy can also affect the _______ artery
Because of its location, Klumpke palsy can also affect the axillary artery this can be from both a hyper-abduction stretch injury, but also a crush injury to the local area. If there is a severe vascular compromise, the patient will undergo emergency surgery. Fractures correlate with this condition, and treatment typically involves surgery. With injuries that are closed, meaning they do not have an obvious break through the skin or are vascular compromised, there is a conservative option.
Spontaneous recovery from nerve palsy is possible
TRUE; Spontaneous recovery from nerve palsy is possible, but it is important to note that most C8-T1 nerve palsies do not recover without intervention. Conservative treatment including exercising supportive muscles and stretching affected muscles, helping to maintain the range of motion and aid in a full recovery. The nerves will heal, but most are mild cases. In 3 to 6 months, if there is no improvement, surgery will take place. Surgical correction mostly involves nerve grafting, but in injuries proximal to the dorsal root ganglion, neurotization is the recommended procedure
Below is a list of the most common differential diagnosis of Klumpke palsy.
Distal ulnar nerve entrapment
Thoracic outlet syndrome
Apical lung tumor
Neurofibroma
Disc herniation
Shoulder impingement
Clavicular or vertebral fracture
Others
Differential diagnosis of klumpke’s paralysis
Similar signs to Klumpke palsy is Erb palsy; this injury affects the upper brachial plexus, which will usually result in dermatome and myotome finds along the C5-C6 path. For example, someone with Erb palsy usually has the “waiter tip” presentation, fixed pronation of the forearm with an outward-facing palm.[2] Another similar condition is the distal nerve entrapment of the ulnar nerve at either the medial epicondyle of Guyon’s tunnel. It is referred to as ulnar nerve entrapment and can produce similar neurological finds as the more proximal Klumpke palsy. One big difference is that there will be no involvement of innervation proximal to the lesion. For example, you will not see pectoralis major involvement with true ulnar nerve entrapment.[12] Thoracic outlet syndrome (TOS) can also show similar symptoms. Typically TOS is a compression injury to the brachial plexus from a rudimentary rib, first rib, or the clavicle on the ipsilateral side, and this could be post-traumatic, postural driven, and or genetic. In contrast to Klumpke, TOS will affect more than just the C8-T1 nerve roots, but like Klumpke, it also can affect the axillo-subclavian artery.
Prognosis of brachial plexus
A 2006 study found a better prognosis in children with a brachial plexus lesion compared to adults undergoing microsurgery. An explanation for this might have to do with a shorter distance, a higher threshold for regeneration, and increased cognitive adaptability.[14] Another article showed similar findings that microsurgery helped restore hand function in 75% of the cases in 8 years.[15] Spontaneous recovery is possible with less intense injuries. Zuckerman and colleagues found that in similar groups, one undergoing surgery and another past the point of surgery had a similar functional outcome in 2 years.[16] Most professions will agree to a better prognosis for more severe injuries with a shorter time to the onset of surgery.
