Klumpke's paralysis involved
(C8, T1) (53-BDC-l 4th)ERB'S PARALYSISKLUMPKE'S PARALYSISSite of Injury - The region of the upper trunk of the brachial plexus is called Erb's point, six nerves meet here. Injury to the upper trunk causes Erb's paralysis.Lower trunk of brachial plexusCause of injury - Undue seperation of the head from the shoulder, which is commonly encountered in (i) birth injury (ii) fall on the shoulder (iii) during anaesthesiaUndue abduction of the arm, as in clutching something with the hands after a fall from a height or sometimes in birth injuryNerve root involved - Mainly C5 and partly C6Mainly T1 and partly C8Muscle paralysed - Mainly biceps, deltoid, brachialis, and brachioradialis. Partly supraspinatus, infraspinatus and supinatorDeformity - (position of the limb)Arm: Hangs by the side: It is adducted and medially rotated.Forearm: Extended and pronatedThe deformity is known as "policeman's tip" or "porter *s tip hand'1. Intrinsic muscles of the hand (Tl)2. Ulnar flexors of the wrist and fingers (C8)Claw hand* due to the unopposed action of the longflexors and extensors of the fingers.(Hyperextension at the MCP joint and flexion at the IP joint)Disability: The following movements are lost1. Abduction and lateral rotation of the arm (shoulder)2. Flexion and supination of the forearm3. Biceps and supinator of the forearm4. Sensation are lost over a small area over the lower part of the deltoid1. Claw hand2. Cutaneous anaesthesia and analgesia in a narrow zone along the ulnar border of the forearm and hand3. Homer's syndrome (This is because of injury to sympathetic fibres to the head and neck that leave the spinal cord through nerve T14. Vasomotor changes5. Trophic changes
C5, 6
C6, 7
C7, 8
C8, T1
Upper Extremity