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Klumpke paralysis
Klumpke's paralysis (or Klumpke's palsy or Dejerine-Klumpke palsy) is a variety of partial palsy of the lower roots of the brachial plexus.〔 p.1046〕 The brachial plexus is a network of spinal nerves that originates in the back of the neck, extends through the axilla (armpit), and gives rise to nerves to the upper limb.〔Warwick, R., & Williams, P.L. (1973). pp.1037-1047〕〔 pp.370-374〕〔 pp.76-77〕〔Shenaq S.M., & Spiegel A.J. Hand, Brachial Plexus Surgery. eMedicine.com. URL: (http://www.emedicine.com/plastic/topic450.htm ). Accessed on: April 13, 2007.〕 (see picture - click to enlarge). It is named after Augusta Déjerine-Klumpke.〔A. Dejerine-Klumpke: Contribution à l’étude des paralysies radiculaires du plexus brachial. Paralysies radiculaires totales. Paralysies radiculaires inférieures. De la participation des filets sympathiques oculo-pupillaires dans ces paralysies. Revue de médecine 1885, 5: 591-616, 739-90.〕
==Cause==
Klumpke's paralysis is a form of paralysis involving the muscles of the forearm and hand, resulting from a brachial plexus injury in which the eighth cervical (C8) and first thoracic (T1) nerves are injured either before or after they have joined to form the lower trunk. The subsequent paralysis affects, principally, the intrinsic muscles of the hand (notably the interossei, thenar and hypothenar muscles)〔 and the flexors of the wrist and fingers (notably flexor carpi ulnaris and ulnar half of the flexor digitorum profundus).〔〔〔(Page 512: Lower Radicular Syndrome (Klumpke Paralysis) ) in: 〕〔Klumpke palsy. Stedman's Dictionary. URL: (http://www.emedicine.com/asp/dictionary.asp?exact=Y&keyword=Klumpke+palsy ). Accessed on: April 13, 2007.〕 Forearm pronators and wrist flexors may be involved, as may dilators of the iris and elevators of the eyelid (both of which may be seen in the case of associated Horner's syndrome). The classic presentation of Klumpke's palsy is the “claw hand” where the forearm is supinated and the wrist and fingers are flexed. If Horner syndrome is present, there is miosis (constriction of the pupils) in the affected eye.
The injury can result from difficulties in childbirth. The most common aetiological mechanism is caused by a traumatic vaginal delivery. The risk is greater when the mother is small or when the infant is of large weight. Risk of injury to the lower brachial plexus results from traction on an abducted arm, as with an infant being pulled from the birth canal by an extended arm above the head or with someone catching himself by a branch as he falls from a tree. Lower brachial plexus injuries should be distinguished from upper brachial plexus injuries, which can also result from birth trauma but give a different syndrome of weakness known as Erb's palsy.
Other trauma, such as motorcycle accidents, that have similar spinal cord injuries to C-8 & T-1, also show the same symptom's of Klumpke's paralysis.
抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』
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