One page summary: Klumpke's palsy

In two sentences

Klumpke's palsy is weakness of the hand and forearm caused by injury to the lower nerves of the brachial plexus, at the C8 and T1 levels. ¹

It is much less common than Erb's palsy and it is generally more serious, because the hand is the part of the arm that matters most for function and because lower root injuries are more often severe. ²

The numbers, with their sources

• Which nerves. The lower roots, C8 and T1, which supply the small muscles of the hand, the finger flexors, and the wrist ¹
• How common. Isolated lower plexus injury is the least common pattern. Most brachial plexus birth injuries involve the upper roots ²
• The associated sign. Horner syndrome, meaning a droopy eyelid and a smaller pupil on the same side, which points to T1 root involvement and a more severe injury ¹
• Why the outlook differs. Lower root injuries are more likely to involve avulsion, in which the root is torn from the spinal cord and cannot recover on its own ²
• The overall rate. Brachial plexus birth injury of all types occurs at around 1.5 per 1,000 live births in the United States ²
• The timing rule. Specialist evaluation early, with the surgical decision window generally between 3 and 9 months ²

What to do this week

1. Ask whether Horner syndrome is present. Ask them to look specifically.
2. Get an early specialist referral. This pattern is uncommon and belongs in a center that sees it.
3. Get a therapy referral today and ask about splinting.
4. Ask whether an MRI is planned to look for root avulsion.
5. Ask about sensation and how to protect the hand.
6. Request the delivery records, including any shoulder dystocia note.
7. Film the hand weekly.

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the specialist team

• Is Horner syndrome present, and what does that tell you?
• Do you suspect avulsion, and will an MRI be done?
• What hand movements are you tracking, and by when?
• If surgery is needed, would it be grafting or nerve transfer?

For the hand therapist

• Should my baby be splinted, and for how many hours?
• Show me the finger and wrist stretches.
• How do I check the hand for injuries my child will not report?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on Klumpke's palsy

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.