Klumpke's paralysis affect -
Ans. is 'c' i.e., C8 T1ERB'S PARALYSISo One region of upper trunk (C CfQ of the brachial plexus is called Erb's point where six nerves meet,o Injury at this point results in Erb's paralysis.o The injury is due to undue separation of the head from the shoulder; which may be seen in : -Birth injuryFall on the shoulderDuring AnesthesiaClinical features of Erb's palsvMuscles paralysed: Mainly biceps brachiiQ, deltoid, branchialis and brachioradialis. Partly supraspinatusQ, infraspinatusQ and supinator.Deformity (position of the limb)Arm : Hanges by the side; it is adducted and medially rotatedQForearm : Extended and pronated0The deformity is known as "policeman's tip hand' or 'porter's tip hand'.Disability : The following movements are lost.o AbductionQ and lateral rotation of the arm (shoulder)Q,o Flexion and supination of the forearmQ,o Biceps and supinator jerks are lost.o Sensations are lost over a small area over the lower part of the deltoid.KLUMPKE'S PARALYSISo Site of injury : Lower trunk of the brachial plexus.o 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.o Nerve roots involved : - Mainly T1 and partly C8.o Muscles paralysedIntrinsic muscles of the hand (T1).Ulnar flexors of the wrist and fingers (C8) 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.o DisabilityClaw handCutaneous anaesthesia and analgesia in a narrow zone along the ulnar border of the forearm and hand.Horner's syndrome if T1 is injured proximal to white ramus communicans to first thoracic sympathetic ganglion. There is ptosis, miosis, anhidrosis, 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).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.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 6C7
C 8T1
C4C5