Klumpke's palsy is due to the involvement of?

Appeared in: DSSSB - 28 August 2019 (Shift-1)

Explanation

Klumpke's palsy is an injury to the lower trunk of the brachial plexus.
The specific nerve roots involved are the 8th cervical (C8) and 1st thoracic (T1).
This injury typically results from hyperabduction of the arm, such as grabbing an object while falling or during a difficult birth.
The paralysis of intrinsic hand muscles leads to a characteristic 'claw hand' deformity.

Option A: Injury to the 5th and 6th cervical nerves (C5, C6) results in Erb's palsy, not Klumpke's palsy.
Option B: While the C8 nerve root is involved in Klumpke's palsy, the C7 nerve root is not the primary other root. The injury specifically involves the lower trunk formed by C8 and T1.
Option C: The 5th and 6th thoracic nerves (T5, T6) are not part of the brachial plexus. They function as intercostal nerves, supplying muscles and skin of the chest wall.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Anatomy and pathophysiology of brachial plexus injuries, specifically Klumpke's palsy as background academic context rather than a clinical decision trigger.
Nurses play a crucial role in the early identification and management of birth-related brachial plexus injuries. Careful assessment of newborn arm movement and reflexes is essential.
Patient and family education is a key nursing responsibility, including teaching proper handling techniques (e.g., avoiding lifting the infant from under the arms) and the importance of physical therapy to prevent permanent disability.
What if? If a patient with Klumpke's palsy also shows a drooping eyelid and a constricted pupil on the same side, the nurse should suspect associated Horner's syndrome. This indicates a more severe injury to the T1 nerve root closer to the spine and requires prompt neurological evaluation.

How to Approach the Question

First, identify the key term in the question: 'Klumpke's palsy'.
This is a factual recall question that requires knowledge of peripheral nerve anatomy.
Recall the structure of the brachial plexus, which is formed by nerve roots C5, C6, C7, C8, and T1.
Differentiate between the two main types of brachial plexus birth injuries: Erb's palsy (upper plexus, C5-C6) and Klumpke's palsy (lower plexus, C8-T1).
Scan the options to find the one that matches the nerve roots for Klumpke's palsy.
Select the option listing the 8th cervical and 1st thoracic nerves.

Concept Tested & Keywords

Concept Tested: Anatomy and pathophysiology of brachial plexus injuries, specifically Klumpke's palsy.
Stem keywords: Klumpke's palsy, involvement, nerve
Lead-in keywords: is due to

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1077-1079

E6 Anatomy BDChaurasia V1 10e p. 61-63

E6 Anatomy Workbook HumanAnatomy Vol 1 p. 76-78

Practise the full DSSSB - 28 August 2019 (Shift-1)

Attempt every question from this paper in a timed mock, then review the full solution for each one.