Klumpke’s Palsy: Causes, Symptoms, and Treatment Options

Klumpke’s palsy is a rare type of brachial plexus injury that affects the lower nerves in your baby’s shoulder, causing weakness or paralysis in the hand and forearm. This condition occurs when the nerves labeled C8 and T1 are damaged during a difficult delivery, often involving excessive pulling or stretching of your newborn’s arm. Parents typically notice their baby cannot move their hand properly or lacks a grasp reflex shortly after birth. While some cases resolve with therapy, others require surgical intervention and can result in permanent limitations that affect your child’s quality of life throughout their development.

If your baby was diagnosed with Klumpke’s palsy following a traumatic delivery, medical negligence may have played a role. A birth injury attorney can review your delivery records at no cost and help determine whether preventable errors caused your child’s nerve damage. Because statute of limitations deadlines restrict how long you have to pursue a claim, it’s important to get answers sooner rather than later. Contact a birth injury lawyer today for a free, confidential case evaluation.

On this page:

• What is Klumpke’s palsy
• Signs and symptoms
• Causes and risk factors
• Diagnosis and testing
• Treatment options
• Recovery and prognosis
• When it’s medical malpractice
• Finding a birth injury lawyer
• Frequently asked questions

What Is Klumpke’s Palsy?

Klumpke’s palsy, also called Klumpke paralysis or lower brachial plexus palsy, is a birth injury affecting the nerves that control movement and sensation in your baby’s hand, wrist, and forearm. This condition specifically involves damage to the C8 and T1 nerve roots—the lower portion of the brachial plexus nerve network that runs from the spine through the shoulder and down the arm.

The brachial plexus consists of five nerve roots (C5, C6, C7, C8, and T1) that branch out to control different parts of the arm. While Erb’s palsy affects the upper nerves and primarily impacts the shoulder and elbow, Klumpke’s palsy affects the lower nerves and primarily impacts the hand and fingers.

This injury is considerably less common than Erb’s palsy, accounting for less than 1% of all brachial plexus injuries that occur during birth. The rarity doesn’t diminish the significant impact on affected children, who may struggle with hand function, grip strength, and fine motor skills needed for everyday activities like writing, eating, and playing.

The severity of Klumpke’s palsy depends on the extent of nerve damage. Nerve injuries are classified into several categories: neuropraxia (stretching), neuroma (scarring), rupture (tearing), and avulsion (complete separation from the spinal cord). Mild stretching injuries often heal on their own within several months, while more severe ruptures and avulsions typically require surgical repair and may result in permanent functional limitations.

Understanding what happened during your child’s birth is the first step toward getting answers—and getting your family the support you deserve.

Signs and Symptoms of Klumpke’s Palsy

Parents often notice symptoms of Klumpke’s palsy immediately after delivery or within the first few days of life. The characteristic sign is weakness or complete paralysis affecting your newborn’s hand and forearm, creating a distinctive appearance that medical professionals call a “claw hand” deformity.

Common symptoms include:

Your baby’s affected hand remains in a flexed position with the fingers curled inward. The wrist typically hangs limp, and your newborn cannot extend or straighten the fingers voluntarily. You may notice an absence of the grasp reflex on the affected side—when you place your finger in your baby’s palm, they cannot close their hand around it.

Muscle weakness in the forearm and hand makes it impossible for your infant to hold objects or bear weight on that arm during tummy time. As your child grows, you’ll observe they cannot perform fine motor tasks with the affected hand, such as picking up small toys, transferring objects between hands, or later developing skills like holding a crayon or spoon.

Sensory changes often accompany the motor deficits. Your baby may have reduced or absent sensation in the hand and inner forearm, though this can be difficult to assess in newborns. Some children experience heightened sensitivity or pain in the affected area, particularly if nerve damage is severe.

Horner’s syndrome is a serious associated condition that occurs in approximately 10-20% of Klumpke’s palsy cases when the injury is severe enough to damage nearby sympathetic nerves. Signs include a drooping eyelid (ptosis), a constricted pupil (miosis), and decreased sweating on the same side of the face as the affected arm. The presence of Horner’s syndrome typically indicates a more serious nerve injury, often involving avulsion of the nerve root from the spinal cord.

Temperature regulation in the affected hand may be impaired. Parents sometimes notice the injured hand feels cooler to the touch compared to the unaffected hand, or that the skin appears slightly discolored or mottled.

Unlike injuries that develop gradually, Klumpke’s palsy symptoms are present from birth. If you suspect your newborn has hand or arm weakness, immediate medical evaluation is necessary to confirm the diagnosis and begin appropriate treatment.

What Causes Klumpke’s Palsy During Birth?

Klumpke’s palsy occurs when excessive force or abnormal positioning during delivery stretches or tears the lower brachial plexus nerves. The injury happens at the moment of birth, typically during the final stages of delivery when your baby’s body is being guided through the birth canal.

Mechanical causes include:

The most common scenario involves your baby’s arm being pulled upward above the head during delivery. This hyperextension stretches the C8 and T1 nerve roots beyond their capacity to withstand tension, causing damage. This positioning can occur during breech deliveries when your baby is born feet-first and the arms become trapped above the head as the body passes through the pelvis.

Shoulder dystocia—a complication where your baby’s shoulder becomes lodged behind the mother’s pubic bone—can also lead to lower brachial plexus injuries, though it more commonly causes Erb’s palsy affecting the upper nerves. When shoulder dystocia occurs and medical providers apply traction to free the trapped shoulder, the pulling force can extend down the entire arm and damage multiple nerve levels.

Difficult or prolonged labor increases the risk of birth injuries. When your baby remains in the birth canal for extended periods, healthcare providers may apply more force during delivery maneuvers, increasing the likelihood of nerve damage.

Risk factors that increase vulnerability:

Large birth weight (macrosomia), particularly babies weighing over 8 pounds 13 ounces, creates a tighter fit through the birth canal. Maternal diabetes often contributes to larger babies, compounding the delivery challenges. These factors don’t cause Klumpke’s palsy directly, but they increase the likelihood that delivery complications will occur.

Breech’s presentation is strongly associated with Klumpke’s palsy. When your baby is positioned feet-first or bottom-first rather than head-down, the arms can become extended overhead during delivery, creating the exact positioning that stresses the lower brachial plexus nerves.

Use of assistive devices during delivery, including forceps or vacuum extractors, increases the risk when used improperly or with excessive force. While these instruments can be necessary in certain situations, they require careful technique to avoid injuring your baby.

Multiple births, particularly twins or triplets, can lead to positioning challenges that increase injury risk. Abnormal fetal positioning, prolonged second stage of labor, and maternal exhaustion during pushing all contribute to difficult deliveries that may result in nerve damage.

Important medical reality: Not every case of Klumpke’s palsy results from medical negligence. Some deliveries involve unavoidable complications that make birth injuries possible even when providers follow proper protocols. However, when healthcare teams fail to recognize risk factors, delay necessary interventions like cesarean section, or use excessive force during delivery maneuvers, they may be liable for preventable injuries.

If you believe medical errors contributed to your child’s Klumpke’s palsy, a birth injury attorney can help determine whether the standard of care was met during your delivery.

How Klumpke’s Palsy Is Diagnosed

Diagnosis typically begins with a physical examination shortly after birth. Your baby’s pediatrician or a pediatric neurologist will assess arm movement, muscle tone, reflexes, and sensory responses. The distinctive “claw hand” posture and absent grasp reflex on one side strongly suggest lower brachial plexus involvement.

Medical providers test specific movements to isolate which nerves are damaged. They’ll observe whether your baby can extend the wrist, spread the fingers, and grip objects. Comparing the affected arm to the unaffected arm helps establish the extent of functional impairment.

Imaging and specialized tests include:

Nerve conduction studies and electromyography (EMG) measure electrical activity in the affected muscles and nerves. These tests, usually performed when your baby is at least three to four weeks old, help determine the severity and location of nerve damage. EMG results can differentiate between temporary nerve stretching and more serious ruptures or avulsions.

Magnetic resonance imaging (MRI) provides detailed images of the brachial plexus nerves and can identify nerve root avulsions, scar tissue, or other structural abnormalities. MRI is particularly valuable when surgical intervention is being considered, as it helps surgeons plan the appropriate approach.

CT myelography, an imaging technique that involves injecting contrast dye into the spinal canal, can detect nerve root avulsions that may not be visible on standard MRI. This test is less commonly used today due to advances in MRI technology but may be recommended in complex cases.

Differential diagnosis considerations:

Healthcare providers must rule out other conditions that can cause similar symptoms. Clavicle fractures, which occur in approximately 1-2% of vaginal deliveries, can limit arm movement and may be mistaken for nerve injuries. X-rays can quickly identify or exclude fractures.

Spinal cord injuries, though rare, can cause arm weakness and must be distinguished from brachial plexus injuries through imaging and clinical examination. Central nervous system conditions and congenital muscular disorders may also present with hand weakness, requiring careful evaluation.

Early and accurate diagnosis is necessary for timely treatment. Nerve injuries heal best when therapy begins immediately, and surgical interventions are most effective when performed within the first several months of life for certain injury types.

Your child’s medical team should monitor recovery closely during the first few weeks and months. Lack of improvement by three to six months may indicate the need for surgical evaluation, particularly if nerve conduction studies suggest complete nerve rupture or avulsion.

Treatment Options for Klumpke’s Palsy

Treatment approaches depend on the severity of your child’s nerve injury, the degree of functional impairment, and how your baby responds to initial therapy. The goal is to maximize hand and arm function, prevent joint contractures, and support your child’s development.

Physical and occupational therapy:

Therapy typically begins within the first few weeks after birth and continues for months or years depending on recovery. Physical therapists teach you gentle range-of-motion exercises to prevent joints from becoming stiff and muscles from tightening. Daily passive stretching keeps the fingers, wrist, elbow, and shoulder flexible even when your baby cannot move them voluntarily.

As your child grows, occupational therapy focuses on developing functional skills. Therapists work on grasp patterns, hand-eye coordination, and strategies to compensate for weakness or limited mobility. They may recommend adaptive equipment or splints to support proper hand positioning and prevent deformities.

Consistency is critical for therapy success. Home exercise programs that you perform with your baby several times daily supplement formal therapy sessions and accelerate recovery.

Surgical interventions:

Surgery may be recommended when nerve damage is severe or when your child shows no improvement after three to six months of therapy. Nerve grafting involves removing damaged nerve segments and replacing them with healthy nerve tissue harvested from another part of your child’s body. This procedure works best for ruptures where the nerve is torn but not avulsed from the spinal cord.

Nerve transfers redirect functioning nerves from nearby muscles to the paralyzed muscles, essentially rewiring the nervous system to restore some movement. This approach is particularly useful when nerve roots are avulsed from the spinal cord and cannot be repaired directly.

Neurolysis removes scar tissue (neuromas) that forms around damaged nerves and can block recovery. This procedure may restore nerve function if the underlying nerve fibers remain intact beneath the scarring.

Timing matters significantly for nerve surgery. Procedures performed within the first six to twelve months of life generally produce better outcomes than delayed interventions, as younger nerves have greater capacity to regenerate and reinnervate muscles.

Secondary reconstructive procedures:

Older children who have residual impairments after nerve repair may benefit from tendon transfers, where functioning tendons are repositioned to restore specific movements. Muscle releases can correct joint contractures that developed despite therapy efforts. Wrist fusions may be performed in severe cases to stabilize the joint and improve overall hand function.

Long-term management:

Your child will likely need ongoing therapy and periodic evaluations as they grow. Developmental milestones should be monitored to ensure your child acquires age-appropriate skills. Adaptive strategies and assistive technology can help your child participate fully in school, sports, and social activities despite functional limitations.

Pain management may be necessary if your child develops chronic discomfort related to the injury or surgical interventions. Some children benefit from psychological support to cope with visible differences or functional limitations that affect self-esteem.

Parents facing the demands of therapy schedules, medical appointments, and potential surgeries often experience significant stress. Support groups and counseling can help your family navigate the emotional and practical challenges of raising a child with Klumpke’s palsy.

Recovery and Long-Term Prognosis

Recovery from Klumpke’s palsy varies widely depending on the severity of the initial nerve injury. Mild cases involving temporary nerve stretching (neuropraxia) often show significant improvement within three to six months, with many babies achieving nearly normal hand function by their first birthday.

Moderate to severe injuries involving nerve rupture or avulsion typically result in incomplete recovery even with optimal treatment. Children with these injuries usually retain some degree of weakness, limited range of motion, or impaired fine motor skills. The functional impact becomes more apparent as your child grows and attempts increasingly complex hand tasks.

Factors influencing recovery:

The type and location of nerve damage play the largest role in determining outcomes. Neuropraxia injuries have excellent prognosis, while avulsions have the poorest prognosis because the nerve is completely separated from the spinal cord and cannot regenerate.

Early intervention significantly improves outcomes. Babies who begin physical therapy within the first month and receive surgical repair within six months when indicated generally achieve better function than those whose treatment is delayed.

Your child’s individual healing capacity and compensatory abilities also matter. Some children develop remarkable adaptations, learning to perform tasks one-handed or developing alternative movement patterns that maximize function despite permanent limitations.

Potential complications:

Joint contractures can develop when muscles remain weak or paralyzed for extended periods. The hand may become fixed in the “claw” position, limiting functional use even if nerve function partially recovers. Aggressive preventive therapy reduces this risk but cannot always prevent it entirely.

Muscle atrophy (shrinkage) occurs in the forearm and hand when nerves cannot stimulate the muscles. The affected arm may appear noticeably thinner than the unaffected arm, and limb length discrepancies sometimes develop as your child grows.

Chronic pain affects some children, particularly those with nerve root avulsions or significant scar tissue. Pain can be difficult to manage and may persist into adulthood.

Functional outcomes:

Many children with Klumpke’s palsy learn to use their affected hand as a “helper hand” that stabilizes objects while the unaffected hand performs fine motor tasks. This functional pattern allows participation in most daily activities, though certain tasks like playing musical instruments, typing quickly, or participating in sports requiring bilateral hand coordination may remain challenging.

Educational and vocational planning should consider your child’s hand function. Early intervention services, school accommodations, and career counseling help maximize your child’s potential and ensure they have the support needed to achieve their goals.

Your family deserves honest information about your child’s likely prognosis. While hope for improvement is appropriate, realistic expectations help you plan for your child’s needs and access necessary services.

When Is Klumpke’s Palsy Medical Malpractice?

Not all cases of Klumpke’s palsy result from medical negligence, but a significant number involve preventable errors during pregnancy management or delivery. Medical malpractice occurs when healthcare providers fail to meet the accepted standard of care, and that failure directly causes harm to your baby.

Common examples of negligence include:

Failure to identify and respond to risk factors during pregnancy is a frequent issue. When ultrasounds reveal a large baby in a diabetic mother, or when breech presentation is confirmed late in pregnancy, healthcare providers should discuss delivery options with you, including the possibility of scheduled cesarean section to avoid traumatic vaginal delivery.

Delayed decision-making during labor puts babies at risk. When labor fails to progress normally, when fetal distress develops, or when shoulder dystocia occurs, every minute of delay increases the likelihood of injury. Obstetricians who hesitate to perform emergency C-sections when indicated may be liable for resulting nerve damage.

Excessive force during delivery maneuvers causes many preventable injuries. Healthcare providers trained in managing shoulder dystocia should use specific, gentle techniques to free the trapped shoulder. Pulling forcefully on the baby’s head and neck, applying downward pressure on the fundus (top of the uterus), or using excessive traction with the baby’s arm can all cause brachial plexus injuries.

Improper use of forceps or vacuum extractors contributes to birth trauma. These instruments require specific training and careful application. Using them incorrectly, applying too much force, or persisting with instrument delivery when it’s clearly not working safely can damage your baby’s nerves.

Failure to obtain informed consent for risky delivery approaches is both an ethical and legal violation. You have the right to understand the risks associated with different delivery methods and to participate in decisions about your care. When providers don’t communicate risks adequately or ignore your concerns, they breach their duty to you and your baby.

Proving medical malpractice:

Birth injury cases require proving four legal elements: duty (the provider-patient relationship existed), breach (the provider deviated from the standard of care), causation (the breach directly caused your child’s injury), and damages (your child suffered actual harm requiring treatment).

Expert medical testimony is necessary in virtually all birth injury cases. Qualified medical experts review your prenatal records, labor and delivery notes, fetal monitoring strips, and your baby’s medical records to determine whether the care you received met accepted standards. They provide opinions about what should have been done differently and whether proper care would have prevented your child’s Klumpke’s palsy.

Medical records are the foundation of your case. Your attorney will obtain complete copies of all relevant records, including prenatal visits, hospital admission notes, nursing assessments, fetal monitoring strips, delivery notes, operative reports if surgery was performed, and your baby’s pediatric records documenting the injury and treatment.

Timing matters. The statute of limitations restricts how long you have to file a lawsuit, and these deadlines vary by state. Many states have special provisions for birth injuries that extend the deadline for minors, but waiting too long can jeopardize your legal rights.

If your child’s Klumpke’s palsy resulted from a difficult delivery, particularly one involving shoulder dystocia, breech presentation, or excessive force, you should consult with a birth injury attorney. A free case evaluation can help you understand whether medical errors played a role and whether pursuing compensation is appropriate for your family.

Finding a Birth Injury Lawyer

Choosing the right attorney to represent your family in a Klumpke’s palsy case can significantly impact both the outcome of your claim and your experience throughout the legal process. Birth injury litigation is a specialized field requiring medical knowledge, access to expert witnesses, and resources to handle complex, expensive cases.

What to look for in a birth injury attorney:

Experience with brachial plexus injury cases specifically matters more than general personal injury experience. Attorneys who have successfully handled Erb’s palsy and Klumpke’s palsy cases understand the medical nuances, know which experts to consult, and can accurately assess your case’s strengths and potential value.

Track record and case results demonstrate an attorney’s capability. While past results don’t guarantee future outcomes, a history of successful settlements and verdicts in birth injury cases suggests the firm has the skills and resources necessary to take on challenging medical malpractice litigation.

Resources to thoroughly investigate and prosecute your case are necessary. Birth injury lawsuits require medical expert witnesses who may charge tens of thousands of dollars for record review, depositions, and trial testimony. Your attorney should be willing to advance all case expenses without requiring you to pay upfront costs.

Communication and accessibility matter throughout the months or years your case is pending. You should feel comfortable asking questions and confident that your attorney will keep you informed about developments. The attorney-client relationship works best when built on trust, transparency, and mutual respect.

Questions to ask during your consultation:

How many brachial plexus injury cases have you handled? What were the outcomes? These questions help you assess the attorney’s specific experience with cases like yours.

Who will actually work on my case? Some firms assign cases to junior attorneys or paralegals after the initial consultation. You should know who will be your primary contact and who will appear in court if your case goes to trial.

What is your assessment of my case? An experienced attorney should be able to provide a preliminary opinion about whether medical negligence likely occurred, though a definitive assessment requires thorough record review.

How long will my case take? While no attorney can guarantee timelines, experienced birth injury lawyers can estimate typical case duration based on your jurisdiction and the complexity of your situation.

What is my case potentially worth? Attorneys cannot guarantee specific amounts, but they can explain the types of damages available and factors that influence case value.

How do you charge for your services? Most birth injury attorneys work on contingency, meaning they receive a percentage of your settlement or verdict only if you win. You should understand the fee percentage, how case expenses are handled, and what happens if your case is unsuccessful.

The value of a free case evaluation:

Reputable birth injury law firms offer free, no-obligation consultations to evaluate potential cases. During this initial meeting, the attorney reviews the basic facts of your situation, asks questions about your pregnancy and delivery, and provides an initial assessment of whether medical malpractice may have occurred.

You’re not committed to hiring the attorney simply by scheduling a consultation. This is your opportunity to gather information, ask questions, and determine whether this attorney is the right fit for your family.

Don’t let concern about cost prevent you from exploring your legal options. If medical negligence contributed to your child’s Klumpke’s palsy, your family may be entitled to compensation for medical expenses, therapy costs, future care needs, and your child’s pain and suffering. An experienced birth injury attorney can help you understand your rights and pursue the accountability your family deserves.

Frequently Asked Questions About Klumpke’s Palsy