National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Klumpke paralysis


Other Names:
Lower brachial plexus palsy; Dejerine-Klumpke palsy; Klumpke's palsy
Categories:
Klumpke paralysis is a rare type of birth injury to the nerves around a newborn’s shoulder, known as the brachial plexus. Most types of brachial plexus injuries affect the shoulder and upper arm. Klumpke paralysis affects the movement of the lower arm and hand. Signs and symptoms include weakness and loss of movement of the lower arm and hand. Some babies experience drooping of the eyelid on the opposite side of the face as well.[1][2] This symptom may also be referred to as Horner syndrome.[2]

Klumpke paralysis is caused by an injury to the nerves of the brachial plexus that which may result during birth due to a a difficult delivery. This injury can cause a stretch injury (neuropraxia), scarring, or tearing of the brachial plexus nerves. Tearing is called an "avulsion” when the tear is at the spine, and “rupture” when it is not. Diagnosis of Klumpke paralysis is made at birth by physical examination. Sometimes x-rays and other tests are done to determine the extent of the nerve damage. Most infants with Klumpke paralysis have the more mild form of injury (neuropraxia) and often recover within 6 months.[1][3]  Some infants will require surgery.[2] Rarely, infants with Klumpke paralysis will have some permanent damage.[2]
Last updated: 1/7/2019
The affected arm may be immobilized across the body for 7 to 10 days.[4] For mild cases, gentle massage of the arm and range-of-motion exercises may be recommended.[5] For torn nerves (avulsion and rupture injuries), symptoms may improve with surgery.[4]   

Most infants recover from the stretch injuries (neuropraxia). After 4 months, additional treatment options may include:[5]

  • Surgery on the nerves (e.g., nerve grafts and neuroma excision)
  • Tendon transfers to help the muscles that are affected by nerve damage work better
Last updated: 1/31/2019
The prognosis of infants and children Klumpke paralysis will depend on the severity of the injury, the time of onset, and initial (early) rate of improvement. For torn nerves (avulsion and rupture injuries), there is no potential for recovery unless surgical reconnection is made in a timely manner.[4]  Most individuals with neuropraxia injuries recover spontaneously with a 90-100% return of function.[4]  It is estimated that up to 88% of infants recover by 4 months, and 92% by 12 months.[6]
Last updated: 1/31/2019

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Organizations Supporting this Disease

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Where to Start

In-Depth Information

  • Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Klumpke paralysis. Click on the link to view a sample search on this topic.

Selected Full-Text Journal Articles

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  1. Abzug JM, Kozin SH. Evaluation and management of brachial plexus birth palsy. Orthop Clin North Am. 2014; 45(2):225-32. https://www.ncbi.nlm.nih.gov/pubmed/24684916.
  2. O’Berry P, Brown M, Phillips L, Evans SH. Obstetrical brachial plexus palsy. Curr Prob Pediatr Adolesc Health Care. 2017; 47(7):151-155. https://www.ncbi.nlm.nih.gov/pubmed/28709767.
  3. Smith K and Patel V. Congenital brachial plexus palsy. Paed Child Health. 2016; 26(4):152-156. https://www.sciencedirect.com/science/article/pii/S1751722216000263?via%3Dihub.
  4. NINDS Erb-Duchenne and Dejerine-Klumpke Palsies Information Page National. Institute of Neurological Disorders and Stroke. Updated 8/19/2018; https://www.ninds.nih.gov/Disorders/All-Disorders/Erb-Duchenne-and-Dejerine-Klumpke-Palsies-Information-Page.
  5. Brachial palsy in newborns. MedlinePlus. Updated 12/13/2017; http://www.nlm.nih.gov/medlineplus/ency/article/001395.htm. Accessed 2/24/2010.
  6. Hill A. Neurological problems of the newborn. In: Bradley WG et al. Neurology in Clinical Practice, 5th ed. Philadelphia, PA: Butterworth-Heinemann; 2008;