Klumpke’s paralysis affect-
ERB’S PARALYSIS

 One region of upper trunk (C# CfQ of the brachial plexus is called Erb's point where six nerves meet,
 Injury at this point results in Erb’s paralysis.
 The injury is due to undue separation of the head from the shoulder; which may be seen in : -

i. Birth injury
ii. Fall on the shoulder
iii. During Anesthesia
 
Clinical features of Erb’s palsv
A. Muscles paralysed: Mainly biceps brachii, deltoid, branchialis and brachioradialis. Partly supraspinatus, infraspinatus and supinator.
B. Deformity (position of the limb)
i. Arm : Hanges by the side; it is adducted and medially rotated
ii. Forearm : Extended and pronated
The deformity is known as “policeman's tip hand’ or ‘porter’s tip hand’.
C. Disability : The following movements are lost.

 Abduction and lateral rotation of the arm (shoulder),
 Flexion and supination of the forearm,
 Biceps and supinator jerks are lost.
 Sensations are lost over a small area over the lower part of the deltoid.

KLUMPKE’S PARALYSIS

 Site of injury : Lower trunk of the brachial plexus
 Cause of injury: Undue abduction of the arm, as in clutching something with the hands after a fall from a height, or sometimes in birth injury,
 Nerve roots involved : - Mainly T1 and partly C8.
 Muscles paralysed

i. Intrinsic muscles of the hand (T1).
ii. Ulnar flexors of the wrist and fingers (C8)
iii. Deformity (position of the hand). Claw hand due to the unopposed action of the long flexors and extensors of the fingers. In a claw hand there is hyperextension at the metacarpophalangeal joints and flexion at the interphalangeal joints.

 Disability

i. Claw hand
ii. Cutaneous anaesthesia and analgesia in a narrow' zone along the ulnar border of the forearm and hand.
iii. Homer’s syndrome if T1 is injured proximal to white ramus communicans to first thoracic sympathetic ganglion. There is ptosis, miosis, anhydrosis, enophthalmos, and loss of ciliospinal
reflex-may be associated. (This is because of injury to sympathetic fibres to the head and neck that leave the spinal cord through nerve T1).
iv. Vasomotor changes : The skin area with sensory loss is warmer due to arteriolar dilation. It is also drier due to the absence of sweating as there is loss of sympathetic activity.
v. Trophic changes : Long standing case of paralysis leads to dry and scaly skin. The nails crack easily with atrophy of the pulp of fingers.
C3C6
C 6 C7
C 8T1
C4C5