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Klumpke Palsy: Causes, Treatment, Prognosis

An adult's hand is holding a baby's hand

Klumpke Palsy can require years of treatment and surgery, and may still leave a child with permanent loss of limb function. Sometimes referred to as Horner Syndrome, the injury most commonly affects the shoulders and upper arms. Parents whose children suffer this birth injury should consult with medical malpractice lawyers who can help secure compensation to cover the costs of surgical intervention, physical therapy, and other expenses associated with the injury. Nationwide, it is estimated that approximately 200,000 people are affected by the injury.

Understanding Klumpke Palsy

Klumpke paralysis occurs when the nerves within the brachial plexus are injured. These nerves run from the spine and travel along the neck, into the armpit area, and down the arm to the hands. It is these nerves that are responsible for controlling movement of the limb and transmitting sensations to the brain.

Injury to these nerves can include stretching of the nerves known as neuropraxia, scarring, rupture, or tearing of the nerves. This paralyzes the affected arm and hand. The severity of the paralysis depends on where the injury occurred, and how severe the initial injury was.

Common symptoms of Klumpke Palsy include minimal arm/hand movement, limp lower arm, diminished reflexes, and stiffness in joints. Infants may also exhibit muscle weakness, clawed hands, tightened fists/fingers, and physical pain.

Causes of Klumpke Palsy

Many cases of Klumpke Palsy are the result of a difficult childbirth. This includes difficult vaginal births that pull and stretch the nerves as the infant travels through the birth canal. It may occur when labor is induced and complications develop, or when the baby has a large birth weight. It is a common injury when the second stage of labor lasts for longer than an hour.

Other risk factors include maternal diabetes and significant maternal weight gain. Women whose first child suffered the injury are at increased risk of this type of complication during subsequent pregnancies.

Diagnosis & Treatment for Klumpke Palsy

Diagnosis of Klumpke Palsy can be made through observation of physical symptoms and confirmed through X-ray, MRI, or other diagnostic imaging scans. These tests can identify the location of the injury and determine the severity of the damage to the nerves. Of particular importance are the condition of the T1 and C8 nerves. If these have been cut or torn, it is unlikely that conservative treatments will have the same benefits as more aggressive, surgical interventions.

Since most cases are the result of stretching injuries, treatment is usually conservative and involves massage and physical therapy. These exercises can improve the infant’s range of motion and reduce pain. These exercises can also stimulate healing of the nerves. Many times, physical therapy treatments involve the application of splints that hold the hand, wrist, and arm in the appropriate position. This typically lasts for seven to ten days and may be repeated several times before improvement occurs.

Physical therapy is a critical component of treatment for Klumpke Palsy. It can expedite recovery and significantly reduce pain and discomfort. It also helps prevent muscle atrophy and stiffness within the joints including the infant’s shoulders, elbow, and wrist. This can positively influence the long-term prognosis and patients who complete these treatments have a better outcome than patients who do not.

However, if the nerves are torn, the infant will most likely require surgical intervention. It is best to perform this procedure between 3 months and 6 months of age. During the procedure, the surgeon will repair or reconstruct the nerves and transfer tendons to improve muscle function. The surgeon will also remove any scar tissue from the damaged nerves which can have a significantly positive result.

Prognosis for Klumpke Paralysis

Most infants who suffer Klumpke paralysis at birth suffer mild forms of the injury and will recover within six months of delivery. However, some with moderate to severe injuries will require surgical intervention and considerable physical therapy.

Studies from the early 2000s indicated that microsurgery was able to restore up to 75% of hand function by age 8. Other studies indicate that up to 88% of infants will recover within four months, rising to 92% at 12 months. In all cases, it is critical that parents not delay treatment as the prognosis is not as positive for older children and adults who undergo the same surgical interventions.

Documenting the Injury

Parents should document every aspect of birth injury. This includes any incidents that occurred during delivery, the date the injury was first suspected, and the results of all diagnostic testing. They should also document symptoms as well as the impact the injury has on the child’s physical development. It is also vital to keep records of the financial expenses incurred for medications, physical therapy, diagnostic imaging, and surgical procedures. Medical malpractice lawyers can use this information to pursue a medical malpractice claim in Illinois.

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