KLUMPKE'S PARALYSIS
Site of injury:
⚫ Lower trunk of the brachial plexus.
Cause of injury:
⚫ Undue abduction of the arm, as in clutching something with the hands after a fall from a height, or something in the birth injury.
Nerve roots involved:
⚫ Mainly T1 and partly C8
Muscles paralysed:
⚫ Intrinsic muscle of the hand(T1)
⚫ Ulnar flexors of the wrist and fingers (C8)
Deformity and POSITI0N of the hand: Claw hand due to the unopposed action of the long flexors and extensors of the fingers. In a claw hand, there is hyperextension at the metacarpophalangeal joints and flexion at the interphalangeal joints.
Disability:
⚫Biceps and supinator jerks are lost.
⚫Complete claw hand
⚫ Cutaneous anaesthesia and analgesia in a narrow Zone along the ulnar border of the forearm and hand.
⚫ Horner's syndrome: If T1 is injured proximal to white ramus communicans to first thoracic sympathetic ganglion, there is ptosis, miosis, anhydrosis, enophthalmos, and loss of cilio-spinal reflex-may be associated. This is because of injury to sympathetic fibres to the head and neck that leave the spinal cord through nerve T1.
⚫Vasomotor changes: The skin area with sensory loss is warmer due to arteriolar dilation. It is also drier due to the absence of sweating as there is loss of sympathetic activity.
⚫ Trophic changes: Long-standing case of paralysis leads to dry and scaly skin. The nails crack easily with atrophy of the pulp of fingers.
Injury to the Nerve to Serratus Anterior (Nerve of Bell)
Causes:
1. Sudden pressure on the shoulder from above.
2.Carrying heavy loads on the shoulder.
Deformity:
Winging of the scapula, i.e. excessive prominence of the medial border of the scapula. Normally, the pull of the muscle keeps the medial border against the thoracic wall.
Disability:
⚫Loss of pushing and punching actions. During attempts at pushing, there occurs winging of the scapula
⚫ Arm cannot be raised beyond 90°, i.e. overhead abduction is not possible as it is performed by the serratus anterior muscle.
