Klumpke’s Palsy

When a newborn arrives with weakness or paralysis in the hand or forearm, parents understandably feel worried and overwhelmed. Klumpke’s palsy is a rare but significant type of brachial plexus injury that affects the nerves controlling movement and sensation in the lower arm and hand. While less common than other forms of nerve injury at birth, learning what Klumpke’s palsy is, how it happens, and what treatment options are available can help families navigate the early weeks and months with greater confidence and clarity.

This page provides clear, medically grounded information to help you understand Klumpke’s palsy, recognize its signs, learn about treatment approaches, and connect with the support your family may need.

What is Klumpke’s Palsy?

Klumpke’s palsy is a specific injury to the lower portion of the brachial plexus, the network of nerves that runs from the spine through the shoulder and down the arm. The brachial plexus controls movement and feeling in the shoulder, arm, hand, and fingers.

In Klumpke’s palsy, the injury involves the lower nerve roots, specifically C8 and T1. These nerves help control the muscles of the forearm, wrist, and hand. When they are stretched, compressed, or torn during birth or later trauma, the baby may lose movement and sensation in the hand and lower arm.

This condition often results in a distinctive appearance called “claw hand,” where the muscles of the hand weaken and the fingers curl or hyperextend. In some cases, nearby sympathetic nerve fibers are also affected, leading to a set of symptoms known as Horner’s syndrome, which can include a drooping eyelid, a smaller pupil, and reduced sweating on one side of the face.

Klumpke’s palsy is much rarer than Erb’s palsy, which affects the upper portion of the brachial plexus and typically involves the shoulder and upper arm.

How Klumpke’s Palsy Happens

Most cases of Klumpke’s palsy occur as birth injuries, particularly during deliveries that involve physical stress on the baby’s neck and shoulders. The injury happens when the lower nerves of the brachial plexus are overstretched or torn.

Several delivery circumstances increase the likelihood of this type of nerve injury:

• Shoulder dystocia, where the baby’s shoulder becomes lodged behind the mother’s pubic bone during delivery
• Breech presentation, especially when the baby’s arms are raised above the head
• Prolonged or difficult labor, particularly a lengthy pushing (second) stage
• Use of birth-assistive instruments such as forceps or vacuum extraction
• Excessive or forceful traction on the baby’s arms, neck, or shoulders during delivery

Certain maternal and fetal factors also raise the risk:

• High birth weight or a larger than average baby
• Maternal diabetes, which can contribute to larger babies
• Abnormal fetal positioning in the womb

While Klumpke’s palsy most commonly occurs at birth, it can also occur later in life after trauma such as falls, motor vehicle accidents, or from compression caused by tumors pressing on the brachial plexus, particularly Pancoast tumors in the upper lung.

Recognizing the Symptoms

Parents and medical providers typically notice signs of Klumpke’s palsy soon after birth. The hallmark symptoms involve weakness or paralysis of the hand and lower arm.

Common signs include:

• Weakness, limpness, or lack of movement in the hand, wrist, and forearm
• A “claw hand” posture, where the hand appears curled or stiff
• Difficulty grasping or gripping objects
• Reduced or absent reflexes in the affected arm
• Pain, numbness, or tingling sensations in the arm or hand
• As the child grows, delayed use of the hand or persistent favoring of the unaffected side

If sympathetic nerve fibers near the lower brachial plexus are also injured, the baby may show symptoms of Horner’s syndrome on the same side as the arm injury. These symptoms can include a drooping eyelid, a smaller pupil in that eye, and decreased sweating on that side of the face.

Any noticeable asymmetry in arm or hand movement, especially combined with facial changes, should prompt immediate evaluation by a pediatric provider.

Diagnosing Klumpke’s Palsy

Diagnosis usually begins with a careful physical examination by a pediatrician or neurologist. The healthcare provider will observe the baby’s movement, muscle tone, reflexes, and posture.

To confirm the diagnosis and understand the extent of the injury, additional tests may be performed:

• Electromyogram (EMG) to measure electrical activity in the muscles and assess nerve function
• Nerve conduction studies to evaluate how efficiently signals travel along the nerves
• MRI or CT scans to visualize the nerve structures and check for tears, ruptures, or avulsion (where the nerve root is pulled away from the spinal cord)
• X-rays to rule out fractures or bone injuries that sometimes occur alongside brachial plexus injuries

These tests help determine whether the nerves are stretched, torn, or completely severed, which guides treatment decisions.

How Common It Is and What to Expect

Brachial plexus injuries at birth occur in roughly 0.8 to 1 out of every 1,000 live births in the United States. Of these, Klumpke’s palsy is considerably rarer than Erb’s palsy and is more often associated with breech deliveries or severe cases of shoulder dystocia.

The prognosis for Klumpke’s palsy depends on the severity of the nerve injury. Nerve injuries are generally classified into three types:

• Neuropraxia, a mild stretch injury where the nerve is intact but temporarily unable to transmit signals
• Rupture, where the nerve is torn but not at the spinal cord
• Avulsion, the most severe type, where the nerve root is torn away from the spinal cord

Most cases involve neuropraxia, which typically heals on its own within three to six months with physical therapy and supportive care. However, more severe injuries involving rupture or avulsion may result in lasting weakness or paralysis and often require surgical intervention.

Early and consistent therapy improves outcomes significantly, even in more serious cases.

Treatment and Medical Care

The approach to treating Klumpke’s palsy depends on the type and severity of the nerve injury. Treatment generally falls into two categories: conservative (non-surgical) management and surgical intervention.

Conservative Treatment

For mild to moderate injuries, the first line of treatment focuses on helping the nerves heal naturally and maintaining range of motion and muscle tone while recovery occurs.

Physical and occupational therapy are essential. Therapists work with families to guide gentle exercises that keep the joints flexible and prevent stiffness or contractures. Therapy often begins within the first few weeks of life.

Parents may be taught how to perform gentle massage, passive range-of-motion exercises, and stretching at home. Splinting or bracing may be used to keep the hand and wrist in a functional position and prevent deformity as the baby grows.

Regular follow-up visits allow the medical team to monitor progress and adjust therapy as needed.

Surgical Treatment

If there is minimal improvement after three to six months of therapy, or if imaging shows a complete nerve tear or avulsion, surgery may be recommended.

Surgical options include:

• Nerve grafting, where a healthy nerve from another part of the body is used to bridge the gap in a torn nerve
• Nerve transfer, where a functioning nerve is redirected to restore movement
• Tendon or muscle transfers, which reroute tendons or muscles to restore hand and wrist function when nerve repair is not possible

Surgery is typically performed by a specialized pediatric neurosurgeon or orthopedic surgeon with experience in brachial plexus reconstruction. Timing is important, and most experts recommend surgery within the first year of life for the best outcomes.

After surgery, physical therapy continues for months or even years to help the child regain as much function as possible.

Multidisciplinary Care

The best outcomes occur when families have access to a team of specialists, including pediatric neurologists, orthopedic surgeons, physical and occupational therapists, and rehabilitation experts. Many hospitals in New York and across the country offer comprehensive brachial plexus injury programs that coordinate care and provide long-term follow-up.

Support for Families

Navigating a diagnosis of Klumpke’s palsy can feel isolating, especially in the early days. Families benefit greatly from education, emotional support, and practical resources.

Major medical centers in New York, including Mount Sinai, NYU Langone, Columbia Presbyterian, and Albany Medical Center, provide neonatal intensive care, specialized therapy services, and family counseling. These centers also offer ongoing follow-up care to monitor development and adjust treatment as the child grows.

Early intervention programs, available through New York State’s Early Intervention Program and similar services nationwide, provide in-home therapy and developmental support at no cost to families of infants and toddlers with developmental delays or disabilities.

Connecting with other families who have experienced brachial plexus injuries can also provide comfort and practical advice. Many hospitals and advocacy organizations facilitate parent support groups, both in person and online.

At nybirthinjury.com, we aim to connect families with trusted medical information and qualified resources to help you find the care and support your child needs.

Advances in Research and Care

Medical understanding of Klumpke’s palsy and other brachial plexus injuries continues to evolve. Researchers are refining surgical techniques, exploring optimal timing for intervention, and studying long-term outcomes to improve care.

Recent studies show that nerve transfer and reconstruction techniques are expanding options for children with severe injuries. Rehabilitation protocols are also becoming more individualized, with a focus on starting therapy as early as possible and tailoring exercises to each child’s needs and progress.

Ongoing research is helping clinicians better predict which injuries will heal on their own and which will benefit from early surgery, allowing for more personalized treatment plans.

Moving Forward After a Klumpke’s Palsy Diagnosis

A diagnosis of Klumpke’s palsy brings uncertainty, but most children with this condition can achieve meaningful recovery, especially with early and consistent care. While some children may experience lasting effects, advances in therapy and surgery offer real hope for improved function and quality of life.

Understanding your child’s diagnosis, staying engaged with their medical team, and advocating for the therapies and services they need will make a significant difference in their development and long-term outcome. You are not alone, and there are many resources available to support your family every step of the way.