Klumpke
Palsy
Klumpke
palsy may produce several abnormal postures. Classically, it produces
flexion and supination of the elbow, extension of the wrist, hyperextension
of the metacarpophalangeal joints, and flexion of the interphalangeal
joints with the “claw hand” posture (Figure 220.1A).
This presentation is rarely seen in the
newborn period. Klumpke syndrome usually manifests in the newborn period
as weakness restricted to or mainly involving the hand (Figure 220.1B).
In many occasions, there are no
reflex or spontaneous movements of the intrinsic hand muscles.
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B |

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Figure 220.1.— Klumpke palsy.
A: classic presentation; B: usual presentation.
The most
frequent sites of involvement are the lower trunk (Figure 220.2 [B]) or
a combination of T1 roots and C8 ventral ramus (Figure 220.2 [A]).
Figure 220.2.— Site of injury in Klumpke palsy. [A] Root of
T1 and spinal nerve of C8. [B] Lower trunk. The green lines at T1 represent
the most frequent origin of sympathetic fibers for the eyes. (PS): paraspinal
muscles; (R): rhomboid muscle; DS: dorsoscapular nerve; LT: long thoracic
nerve; (SA): serratus anterior muscle; (SS): supraspinal muscle; (IS):
infraspinal muscle; SPS: suprascapular nerve; PL: pectoral lateralis nerve;
(P): pectoralis muscle; PM: pectoralis medialis nerve; SF: sympathetic
fibers to the eyes; (M of M): muscle of Müller; (DP): dilator pupillary
muscle; (TM): teres major muscle; (SBS): subscapularis muscle; SBS: subscapularis
nerves; TD: thoracodorsal nerve; (LD): latissimus dorsi muscle; MC: musculocutaneous
nerve; (Bi): biceps muscle; (Br): brachialis muscle; M: median nerve;
U: ulnar nerve; A: axillary nerve; (TMi): teres minor muscle; (D): deltoid
muscle; R: radial nerve.
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