Klumkpe’s palsy

Every child needs his or her limbs to be able to move about and do the very things they love best – play – but in order to achieve that the child usually needs both hands and legs. It’s quite difficult for seven-year-old Kevin to get involved in throw and catch at school and put on his clothes with little help from his parents. Kevin was diagnosed with Klumpke’s palsy of his right upper limb at birth.
Introduction

Klumkpe’s Palsy or Dejerine-Klumpke Palsy refers to weakness in the upper limbs as a result of injury to the lower brachial plexus. Nerves from the bones in the neck region come together to form the brachial plexus and this passes under the collar bone and into one upper limb.

When there is damage to the lower aspect of the brachial plexus (C8 and T1 nerve roots), Klumpke’s Palsy arises.

Presentation of the Upper Limb

The new born

The lower brachial plexus connects to the muscles of the upper limb and when damaged, the affected upper limb becomes weak and does not have a lot of movement as compared to the other unaffected upper limb.

The baby typically holds the forearm with the palm facing forwards with the elbow bent, wrist held back and the hand in a claw-like position. In most cases, more than 50 per cent of the baby’s who have this condition have their right upper limb affected than the left upper limb.

The upper limb with the paralysis also has sensation problems – touch and temperature. The baby is unable to detect when for example he is pinched on the arm, but he readily responds with a cry when the unaffected arm is pinched.

The affected arm is also less warm as compared to the rest of the body and is unable to distinguish between warm and cool water.  The baby would normally find it a challenge to move the whole arm or even use the fingers to grip or hold onto an object.

The older child

The severity of the damage correlates a lot with the presentation of the affected arm as the child gets older. The older child has challenges with lifting the arm sideways and whenever they try to do so the middle part of the scapula projects above the shoulder line; this is known as Putti sign. The active range of motion of the affected arm is also limited in forward movements and in bending the elbow.

Mostly when the children place food into their mouths, they perform that movement by raising their affected arm sideways and then bending at the elbow. The name used for this movement is the "trumpet sign."

Some children may have subluxation /dislocation at the affected shoulder due to some of the shoulder muscles becoming too tight. Also due to lack of movement and disuse of the upper limb, it is smaller and shorter as compared to the unaffected arm.

What are the Causes/ Risk Factors?

There are various risk factors involved in the injury to the lower brachial plexus. A few include:

• The injuries transpire when the shoulder of the baby become impacted during delivery, causing the lower brachial plexus (C8 and T1) to stretch or tear. The severity and prognosis of the injury depends on whether the nerves have been torn or whether it was stretched.
• It may also occur when the brachial plexus in some cases are stretched in the womb/uterus just when the baby is about to be born and there is no traction involved during delivery.
• During labour, damage to the baby's brachial plexus may take place if the child is unusually large, above 3.8 kg

Breech presentation – baby does not appear with the head during delivery

 To be continued...

By Dorothy Akua Adjabu