Klumpke's palsy or Klumpke's paralysis is a kind of palsy that affects the muscles of the forearm, hand, wrist, and fingers. Palsies are caused by damage to the brain, spinal cord, or nervous system that cause sensory and motor control loss to various parts of the body. Klumpke's palsy is caused by damage to the upper portion of the brachial plexus, a nerve system which originates at the spinal cord in the back of the neck and continues through the upper arm. The brachial plexus controls sensation and movement in the forearm, hand, wrist, and fingers.

Symptoms:
Individuals with Klumpke's palsy may hold their hand in a 'claw' position, and may have problems controlling the muscles of the lower arm and hand, and also have loss of feeling in those areas. Severe pain can also be present for a time directly after occurrence of the injury. Horner's Syndrome, which affects the muscles that control dilation of the pupil and the eyelids, is sometimes present in conjunction with Klumpke's palsy .

Causes:
Damage to the nerve roots at the spinal cord in the neck at vertebrae C8 and T1 causes the kind of symptoms seen in Klumpke's palsy. Injury to the nerves can result from a difficult birth if the fetus's arm or head was tractioned or manipulated with too much force such that the nerves were hyper extended or torn during delivery, especially in cases of breech presentation or in the event of shoulder dystocia, when the fetus's shoulder had been impacted against the mother's pubic bone. Brachial plexus nerve damage can also result from a tumor composed of nerve cells growing on the nerve, or spinal cord injury from infection or oxygen deprivation during fetal development (rare). Individuals involved in contact sports or activities, such as diving or skiing, that put the body at risk for high-impact injuries to the head, neck, and shoulder may sustain brachial plexus nerve injury. Other trauma, such as from falling or from car, bicycle, boating, or motorcycle accidents, can cause damage to the brachial plexus nerve.

In the most severe injuries, the nerve is torn from its root at the spinal cord or somewhere along the nerve (avulsion & rupture). Nerves that have been damaged, either due to a tumor or from injury, and healed, leaving scar tissue that interferes with the proper functioning of the nerve is called neuroma. The least severe injury that can best heal without residual complications is called neuropraxia, when the nerve has only been hyper extended, and is the most frequently occurring severity of brachial plexus injury.

Complications:
As with other forms of palsies, the most frequent complication is joint stiffness and contractures, loss of muscle tone and sensation in the afflicted areas. Nerve damage can also cause severe and / or constant pain. Vertebral alignment problems, such as scoliosis, and reduced bone density can result after many years of unbalanced muscle tone and activity.

Prognosis and Treatment:
Most children born with an injury to the brachial plexus nerve system recover quickly and have no long-lasting effects; however, for the few (less than 200,000 total cases in the United States ) whose symptoms persist beyond the first few weeks of life, physical and occupational therapies are the most common and useful treatments. In the first few weeks of life, a child with a brachial plexus injury must be treated with extra care when moving the head, neck, arms, and shoulders to prevent further damage to the nerves. Care-givers can learn how to massage, stretch, and assist with strengthening exercises for an infant with a brachial plexus injury to help the rehabilitation process of nerves and maintain muscle tone. Certain kinds of wrist and elbow splints may be used at times to reduce development of joint contractures (severe stiffness in the joint such that complete extension is impossible). For the most severe cases, those of anoxia and rupture, surgical procedures that re-attach the nerves is required to restore sensation and motor control, if any.