Klumpke’s Palsy

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Klumpke’s palsy is a condition that causes loss of sensation and paralysis in the lower arm, wrist, and hand. It can occur in newborns with nerve damage from complications during labor and delivery. A baby with this condition may have mild, temporary symptoms or a permanent disability, depending on the severity of damage to the nerves.

What Is Klumpke’s Palsy?

Klumpke’s palsy is a condition, most often a birth injury, that results from damage to specific nerves of the brachial plexus.[1] The brachial plexus nerves run from the spine, along the side of the neck, through the armpit area, and down the arm. They allow for movement and sensation in the arm, wrist, and hand.

When the nerves that run to a specific area in the lower part of the arm, mostly the wrist and hand, are damaged, the resulting injury is known as Klumpke’s palsy. This is a type of brachial plexus palsy, sometimes also referred to as Dejerine-Klumpke palsy.

In general, palsy refers to a type of paralysis, although it does not necessarily mean complete paralysis. A palsy can cause a range of symptoms, from muscle weakness to uncontrolled movements to partial or total paralysis of muscles.

What Causes Klumpke’s Palsy?

The ultimate cause of Klumpke’s palsy is some degree of damage to the brachial plexus nerves. The types and degrees of injuries, listed from milder to more severe, include:

• Stretching
• Scarring
• Rupture, tearing of the nerves in place
• Avulsion, a tearing of the nerves away from the spine

Brachial plexus injuries occur most often in newborn babies due to birth trauma and injury. Potential complications of pregnancy and childbirth that may increase the risk of developing Klumpke’s palsy include:

• A difficult vaginal birth that causes pulling and stretching of the nerves
• A baby in a breech or other abnormal position in the birth canal
• Labor induction or abnormalities
• A large birth weight
• Substantial maternal weight gain
• Operative vaginal delivery with improper use of forceps or other delivery tools
• Maternal diabetes
• Previous delivery with this type of complication
• The second stage of labor lasts more than an hour

Klumpke’s palsy can develop at any age. Other causes of this condition include accidents and traumatic injuries that damage the nerves, as well as tumors around the brachial plexus nerves.

Symptoms and Diagnosis

A baby with Klumpke’s palsy may exhibit a range of symptoms. Some may be immediately obvious, while they are mild enough to go unnoticed initially in other cases.

• Limp lower arm, minimal arm, and hand movement
• Poor reflexes
• Sensory loss
• Paralysis
• Stiff joints
• Pain
• Muscle weakness and atrophy
• Claw hand, tightened hand, and fingers

A newborn with Klumpke’s palsy holds the arm in an unusual way. The palm may be turned upward or outward while the elbow remains bent. The symptoms range from mild to severe, depending on the extent of nerve damage.

Observing the symptoms is often enough for a doctor to diagnose Klumpke’s palsy. A doctor may use X-rays, an MRI, or another type of imaging scan to look for damage. These tests can confirm the diagnosis, determine the location of the damaged area, and estimate the severity of the injury.

Tests of electrical activity and nerve conduction can also confirm nerve damage and help determine its severity.

Treatment of Klumpke’s Palsy

There are several treatment options for Klumpke’s Palsy. Most cases are caused by stretch injury, and they usually resolve in the first six months. For these milder cases, your doctor will likely recommend you begin with non-surgical interventions.

Newborns can typically begin gentle massage and physical therapy right away. Exercises help improve range of motion, reduce pain, and encourage healing in the nerves. A therapist may also recommend splints to hold the hand, wrist, or arm in proper alignment.

For more severe cases of Klumpke palsy, when the nerve is torn instead of just stretched, a child may need surgery. Treatment is usually conservative, beginning with therapy and progressing to surgical intervention if there is inadequate improvement after three to six months.[2]

Surgery may be the best option to repair or reconstruct nerves, transfer tendons for muscle movement, remove scar tissue from damaged nerves, or even graft a new nerve to replace a damaged one entirely.

Prognosis

Most babies recover from Klumpke’s palsy. However, compared to nerve damage higher in the arm, those injuries that result in lower arm palsies are less likely to recover spontaneously.

In other words, some type of treatment or intervention is usually necessary for a good prognosis. The earlier that treatment begins, the better the expected outcome. Nerve injuries at the more severe end of the spectrum will generally require surgery.

If there are ruptured nerves, according to the National Institute of Neurological Strokes and Disorder, “there is no potential for recovery unless surgical reconnection is made promptly.”[3]

Taking Legal Action

Sometimes, when a baby is born with brachial plexus injuries, no one is to blame. But in many cases, a medical professional’s decision or failure to act can be found to be the underlying cause.

A nurse, midwife, or doctor could use too much force, misuse birthing instruments, fail to order a C-section in spite of complications, or fail to diagnose or treat complications like diabetes in the mother.

If you believe that your child’s Klumpke’s palsy and disability could and should have been prevented, you may have a case for taking legal action. A birth injury lawyer can help you determine if medical malpractice occurred and your chances for a successful lawsuit.

The right lawyer will help you to recover damages that will assist in the hardship of paying for medical and other expenses related to the injury and obtain justice for you and your child.