KLUMPKE’S PARALYSIS

RAJATH KUMAR
8TH TERM
ROLL NO:59
 Lower brachial plexus injury
 The nerve roots involved in this injury are C8 and T1
and sometimes C7.
 caused by the hyperabduction of the arm, which may
occur when one falls on an outstretched hand or an
arm is pulled into machinery or during delivery
(extended arm in a breech presentation
CLINICAL FEATURES
 Claw hand: due to paralysis of the flexors of the
wrist and fingers (C6, C7, and C8), and all intrinsic
muscles of the hand (C8 and T1)..
 Loss of sensations along the medial border of the
forearm and hand (T1).
 Horner’s syndrome (characterized by partial ptosis,
miosis, anhydrosis, and enophthalmos) due to
involvement of sympathetic fibres supplying head and
neck, which leave the spinal cord through T1.
CLINICAL TESTS

Froment’s sign
 reliable clinical test for ulnar nerve injury
 Three muscles (first palmar interossei, adductor
pollicis and flexor pollicis longus) are required to hold
a book between the thumb and other fingers.
 In ulnar nerve injury, the first two muscles are
paralyzed and now to hold the book, the patient has to
depend only on flexor pollicis longus, which flexes the
thumb prominently. This is the positive Froment’s sign.
CLINICAL TESTS

Card test
 Inability to hold a card or paper in between fingers
due to loss of adduction by the palmar interossei
CLINICAL TESTS

Egawa test
 With palm flat on the table the patient is asked to
move the middle finger sideways .
 This is a test for the dorsal interossei of middle finger.
 What is ulnar paradox?
 The higher the lesion of the median and ulnar nerve
injury, the less prominent is the deformity and vice
versa.
 This is because in higher lesions the long finger
flexors are paralyzed.
 The loss of finger flexion makes the deformity look
less obvious.
TREATMENT
For Claw Hand Deformity
Principles of treatment:
 All the treatment measures aim at blocking the
hyperextension at the metacarpophalangeal joint.
 Once this joint is stabilized, the long extensors will
bring about the extension of IP joints.
 The long finger flexors will help in flexion of the MP
joints along with their action of finger and wrist
flexion.
 Methods of Stabilization of MP Joints
 This can be done by the active method, which
involves tendon transfer,
or
 passive method, which involves arthrodesis,
capsulodesis or tenodesis.
 Active method
 This is by tendon transfers.
 A neighboring healthy tendon is brought to replace the
action of the lost intrinsic.
 The available normal tendons and the existing local
situations dictate the choice of the tendon.
 Whichever the tendon chosen, it is passed through the
lumbrical canal and is attached to the dorsal digital
expansion, which then brings about the action of the
lost intrinsics.
 Before resorting to tendon transfers, certain criteria
are to be followed
 CRITERIA FOR TENDON TRANSFERS
 The tendon should have a muscle power grade 5 preferably. If not at least
grade 4 because after the transfer it loses its muscle power by one grade.
 It should have its own nerve and blood supply.
 Transfer should be done from the synergistic group because rehabilitation
will be easier. The tendon should be routed in a straight line and should be
ensured to have sufficient padding to prevent wear and tear.
 Tendon should be sutured in moderate tension.
 Prior to tendon transfer, joint stiffness, contractures and malunion of bones
should be corrected.
 Age of the patient should be minimum of 5 years.
 The disease should not progress.
 Any infection of bone and joints should be controlled.
 There should be good range of passive movements available at the joints.
CHOICE OF SURGERY

All surgeries aim at correcting the hyperextension at MP

joint.
 Modified Bunnel’s Operation
 Riordan’s Operation
 Brand’s Operation
 Fowler’s Operation
Passive method
 MP joint is stabilized by capsulodesis, tenodesis or
arthrodesis
THANK YOU