Klumpke's palsy: when the injury reaches the hand

Klumpke's palsy is injury to the lower portion of the brachial plexus: the C8 and T1 nerve roots. Where Erb's palsy takes the shoulder and spares the hand, Klumpke's palsy does the reverse. The small muscles of the hand and the flexors of the wrist and fingers lose their nerve supply, while the shoulder may work normally.

What it looks like

The characteristic posture is a "claw hand": fingers flexed, a weak hand, and poor or absent grasp on the affected side. Because newborns are expected to keep their hands fisted much of the time, an isolated lower-plexus injury is easier to miss than Erb's palsy, and some cases are first appreciated when a baby fails to develop grasp on one side.

One associated finding deserves its own mention. Horner's syndrome is a drooping eyelid, a constricted pupil, and decreased facial sweating on the affected side. The T1 root carries sympathetic fibers to the eye and face, so Horner's syndrome alongside an arm injury signals damage very close to the spinal cord, raising the concern for root avulsion. It is a finding that should prompt thorough imaging and specialist referral, promptly.

How lower-plexus injuries happen

The lower roots come under tension in a different geometry than the upper roots, classically when the arm is extended overhead during delivery and the body is pulled, as can occur with a trapped posterior arm or in a breech extraction, and in severe traction injuries that involve the whole plexus. Isolated Klumpke's palsy is considerably rarer than Erb's palsy; when lower-root findings are present, they often accompany a broader injury, which is one reason careful early evaluation matters.

Prognosis and the legal picture

Lower-plexus injuries carry a more guarded outlook for spontaneous recovery than upper-plexus stretch injuries, and hand function is both the hardest thing to restore surgically and the most consequential to live without. Fine motor control is what buttons shirts, writes, types, and works. A child with persistent hand involvement needs specialist care early, and the family needs the legal analysis early for the same reasons as every pattern on this site: the injury is peripheral-nerve, so NICA usually does not bar the claim; Florida protects the claim until the child's eighth birthday; and the records that explain the delivery do not get easier to assemble with time.