What is Klumpke’s palsy?
Klumpke’s palsy is weakness or paralysis of the hand and forearm caused by injury to the lower nerves of the brachial plexus, the eighth cervical and first thoracic nerves (C8–T1), usually from upward traction on a baby’s arm during a difficult delivery. It is considerably rarer than Erb’s palsy, which affects the upper roots, and it tends to be more disabling because the hand — the arm’s most intricate tool — is what loses function. The hallmark is a “claw hand”: the wrist and fingers cannot extend and curl into a claw-like posture.
Klumpke’s palsy is one of the injuries in the brachial plexus family. It can occur alone, but the lower roots are also involved in the most severe (global) brachial plexus injuries, where the entire arm is affected.
The nerves involved: C8–T1
The lower roots of the brachial plexus, C8 and T1, supply the small muscles of the hand (the ones that flex the fingers and let them spread, pinch, and grip) along with the wrist flexors. They also carry sympathetic nerve fibers that travel up to the eye. That anatomical detail explains the injury’s two signatures: a paralyzed, clawed hand, and, when T1 is torn near the spinal cord, Horner’s syndrome in the eye on the same side.
What causes Klumpke’s palsy
Where Erb’s palsy typically comes from lateral traction on the head, classic Klumpke’s palsy is associated with the arm being pulled upward, overstretching the lower roots. Contributors include:
- Delivery with the arm raised overhead, which stretches C8–T1, the classic mechanism.
- Breech delivery, where traction on the trunk with an extended arm can injure the lower plexus.
- Shoulder dystocia managed with excessive or misdirected traction; see shoulder dystocia.
- Macrosomia and instrument-assisted delivery.
Signs: claw hand and Horner’s syndrome
- Claw hand: the wrist is bent, the knuckles hyperextend and the finger joints flex, producing a claw-like posture; the hand cannot grip.
- Absent grasp reflex on the affected side, with preserved shoulder and elbow movement.
- Sensory loss along the inner forearm and hand.
- Horner’s syndrome: a drooping eyelid (ptosis), a constricted pupil (miosis), and reduced sweating on that side of the face, caused by injury to the T1 sympathetic fibers. Its presence signals a severe, often avulsion-type injury and a poorer prognosis.
Klumpke’s vs. Erb’s palsy
| Feature | Erb’s palsy | Klumpke’s palsy |
|---|---|---|
| Nerve roots | Upper (C5–C6) | Lower (C8–T1) |
| What’s weak | Shoulder and upper arm | Hand and forearm |
| Classic posture | “Waiter’s tip” (straight, inward-rotated arm) | “Claw hand” |
| Grip | Usually preserved | Lost |
| Horner’s syndrome | Uncommon | May be present (T1 involvement) |
| Frequency | Most common | Rare in isolation |
Treatment and outlook
As with Erb’s palsy, care begins with physical and occupational therapy to keep the hand and wrist mobile and prevent contractures while the nerve is given time to recover. Splinting is often used to hold the wrist and fingers in a functional position. When there is little recovery of hand function by around three to six months, evaluation at a specialized brachial plexus center for nerve grafting or transfer is appropriate, ideally within the first year. Isolated Klumpke’s palsy carries a more guarded outlook than upper-root Erb’s palsy, because hand function is harder to restore and the presence of Horner’s syndrome often means an avulsion injury. Many of the same therapy and surgical principles on our Erb’s palsy treatment page apply.
Did your baby’s hand injury follow a difficult delivery or a shoulder dystocia? The delivery records can show how the arm was handled. Our attorneys review them at no cost.
Was it preventable?
Not every case of Klumpke’s palsy is malpractice. Some injuries occur despite careful delivery, particularly in unavoidable breech or malpositioned births. But like Erb’s palsy, Klumpke’s palsy is a traction injury, and the standard of care asks whether the arm was subjected to excessive or misdirected force where recognized maneuvers were called for, and whether the resulting injury was documented and referred promptly to a specialist. When avoidable traction tore the lower roots, the injury may have been preventable.
Legal options for families
A Klumpke’s palsy claim asks whether the delivery met the standard of care and whether a failure caused the nerve injury. Because the hand is so central to independence, a permanent lower-plexus injury can carry high lifetime costs (therapy, surgery, adaptive equipment, and lost earning capacity) quantified in a life-care plan. Published brachial plexus settlements illustrate the range, though prior results never guarantee an outcome. Filing deadlines vary by state; see our statute of limitations guide.
Where your case is handled depends on where the birth occurred: Banville Law attorneys are licensed in New York and Washington, D.C.; The Weitz Firm attorneys are licensed in Pennsylvania and New Jersey; elsewhere, the alliance connects families with its vetted network of local birth injury attorneys.
Frequently asked questions
Is Klumpke’s palsy worse than Erb’s palsy?
Isolated Klumpke’s palsy tends to have a more guarded outlook because it affects the hand, which is harder to rehabilitate, and it more often involves nerve-root avulsion (signaled by Horner’s syndrome). Erb’s palsy, affecting the upper roots, more commonly recovers spontaneously.
What is the claw hand in Klumpke’s palsy?
It is the characteristic posture caused by paralysis of the small hand muscles: the wrist bends, the knuckles hyperextend and the finger joints curl, and the hand cannot grip. It reflects loss of the C8–T1 nerve supply.
What does Horner’s syndrome mean in my baby?
A drooping eyelid and small pupil on the same side as the arm injury indicate that the T1 nerve root was severely injured, often torn from the spinal cord. It signals a more serious injury and a poorer prognosis, and it should prompt referral to a specialized center.
Can Klumpke’s palsy be cured?
Milder stretch injuries can recover with therapy. More severe injuries may need nerve surgery within the first year, and some deficit can be permanent, especially with avulsion. Early specialist evaluation gives the best chance of restoring function.
Sources
- National Institute of Neurological Disorders and Stroke (NINDS). Brachial Plexus Injuries Information.
- American Academy of Orthopaedic Surgeons (AAOS). Brachial Plexus Birth Palsy.
- Al-Qattan MM, et al. Klumpke’s birth palsy: a review. Journal of Hand Surgery (European Volume).
- American College of Obstetricians and Gynecologists (ACOG). Neonatal Brachial Plexus Palsy.
This page is for general education and is not medical advice. Medical facts above are drawn from the cited primary sources; legal statements reflect the reviewing attorneys’ professional experience. Always consult your child’s physician about medical concerns.