What is Klumpke’s palsy?
Klumpke’s palsy is caused by an injury to a part of the brachial plexus nerve which runs through the neck and shoulder. It is often the result of an avoidable injury known as shoulder dystocia, which occurred during the childbirth process.
Shoulder dystocia occurs when excessive pulling on the head or shoulders of an infant during a normal delivery or by arms that are raised over the head during a breech delivery. In most cases, Klumpke’s palsy is a neuropraxia injury which may allow for complete recovery over a period of time. In some cases, however, the injury is more severe and may result in long-term or even permanent disability.
How is Klumpke’s palsy different from Erb’s palsy?
Klumpke’s palsy and Erb’s palsy are similar injuries, often caused by the same type of pressure which damages the brachial plexus nerve. The difference is in the area of the brachial nerve and the area in which symptoms occur.
Klumpke’s palsy affects the lower portion of the brachial nerve at the C-7 and T-1 vertebrae and has symptoms that occur mainly in the forearm or hand. Erb’s palsy affects the upper portion of the brachial nerve at the C-5 and C-6 vertebrae and has symptoms that affect the upper arm or the entire arm. Erb’s palsy may occur at a higher rate than Klumpke’s palsy but the incidence may vary by region and location.
What causes Klumpke’s palsy?
Klumpke’s palsy occurs in 0.5 to 1.45 of every 1,000 births. It occurs when the brachial plexus nerve is stretched or damaged due to the arm, neck or shoulder being forced into an abnormal position during birth. It usually occurs during a difficult vaginal delivery and is caused by shoulder dystocia. Most commonly, Klumpke’s palsy is a result of the arms being pulled over the head during a head-first (cephalic) or raised over the head because of a feet-first (breech birth).
The risk of Klumpke’s palsy and other shoulder dystocia injuries is increased during difficult deliveries. Larger babies, twin pregnancies and breech positioning may result in prolonged labor and increased risk. Increased maternal weight and mothers with diabetes are also at increased risk.
Labor induction and the use of forceps during delivery has been shown to increase the risk of all types of shoulder dystocia injuries and other birth trauma events. A cesarean section may decrease the chance for a birth injury when conditions indicate a difficult delivery is probable.
Types of Klumpke’s palsy
Though Klumpke’s palsy is typically described as an injury to the lower brachial nerve, it can be further categorized according to extent of injury and potential for recovery.
- Neurapraxia – the majority of Klumpke’s palsy injuries fall into the neurapraxia category. It occurs when the brachial nerve is stretched but not ruptured or torn. In most cases, neurapraxia will heal over a period of time, restoring function.
- Neuroma – occurs when scar tissue develops after a stretched nerve injury. Scar tissue formation may inhibit recovery and may result in some permanent disability.
- Rupture – a torn nerve is described as “ruptured”. In most cases, a ruptured nerve will not heal without surgery and even when repaired, may result in permanent disability.
- Avulsion – the most severe type of Klumpke’s palsy is fortunately also the rarest. Avulsion occurs when the brachial nerve tears away from the spinal cord. In some cases, a nerve graft may be performed using tissue from another part of the body or donor but in most cases, disability may be permanent.
Symptoms of Klumpke’s palsy
Signs of Klumpke’s palsy due to birth injury begin immediately and are usually obvious. Symptoms include:
- Handheld in shape of a “claw”
- Hand and wrist held close to the body
- A weakness of arm or hand
- Limpness in one hand
- Stiffened joints
- Numbness or lack of feeling in arm or hand
- A weakness of grip in one hand
In some occurrences of Klumpke’s palsy, the infant will also have additional damage known as “Horner’s syndrome” which results in a constricted pupil of eye opposite to affected arm.
Klumpke’s palsy treatments
Infants with Klumpke’s palsy or paralysis may recover over time. The earlier Klumpke’s palsy is diagnosed, the more likely recovery will be. Treatment should be started immediately when possible. Neuropraxia, the mildest category, may show improvement in four to six months.
In many cases, the physician may recommend immobilization and rest for the affected arm for a period of weeks. This may be followed by physical therapy treatments including massage and exercise to increase the range of motion. In severe cases, when the nerve was ruptured or severed, surgery may be required to repair or replace nerve tissue.
Klumpke’s palsy prognosis
If diagnosis and treatment begin within a few weeks of birth, up to 90% of Klumpke’s palsy may be resolved during the first year. After the first few weeks, the recovery may drop to 80% and some cases may be permanent, depending on severity.
Treatment of a shoulder dystocia injury which results in Klumpke’s palsy may be time-consuming and costly. The child’s arm or hand may not grow or develop at the same rate and may be smaller than normal. In some cases, the arm or hand may not be fully functional and a child may face social difficulties related to a stunted arm or disability. Children may have self-esteem issues or frustration challenges and may benefit from supportive psychological therapy.
When Klumpke’s palsy has developed due to an avoidable birth injury like shoulder dystocia, parents or caregivers may be eligible for assistance or legal compensation for medical costs, pain and suffering, disability and other expenses.