Klumpke's Palsy: Causes, Symptoms & Physiotherapy Rehabilitation Guide

Klumpke's Palsy: From Anatomy to Rehabilitation

Klumpke's palsy results from injury to the lower trunk of the brachial plexus — specifically the C8 and T1 nerve roots. The lower trunk innervates the intrinsic muscles of the hand (interossei, hypothenar muscles, thenar muscles via the median nerve's C8 component) and the finger flexors.

Anatomical Basis

The brachial plexus lower trunk emerges between the C8 and T1 vertebrae and passes through the posterior triangle of the neck, under the clavicle, and through the axilla. Injury occurs when the arm is violently abducted (pulled upward) or stretched overhead, stretching the lower trunk.

Clinical Presentation

• Claw hand deformity: Hyperextension of MCP joints and flexion of IP joints (ring and little finger predominantly)
• Loss of finger abduction/adduction: Weakness of dorsal and palmar interossei
• Weak grip strength: Loss of flexor digitorum profundus to digits 4-5
• Hypothenar muscle wasting: Flattening of the ulnar palm eminence
• Horner's syndrome (in severe cases): Ptosis, miosis, anhidrosis — due to interruption of cervical sympathetic fibers at T1

Physiotherapy Rehabilitation Protocol

Phase 1: Acute Management (0–4 Weeks)

• Splinting: Cock-up wrist splint to prevent wrist drop; dorsal blocking splint to prevent MCP hyperextension
• Passive Range of Motion: All finger, wrist, and thumb joints daily to prevent contracture
• Edema management: Retrograde massage, elevation, gentle compression

Phase 2: Nerve Recovery Phase (4 Weeks – 6 Months)

• Sensory re-education: Tactile discrimination exercises (texture identification, localization)
• Mirror visual feedback: For severe denervation — reduces central maladaptation
• FES (Functional Electrical Stimulation): Stimulate hand intrinsics to maintain muscle bulk during denervation
• Progressive active exercises: As voluntary motor units return (track with MMT grading monthly)

Phase 3: Functional Retraining (6 Months+)

• Grip strengthening: Putty exercises, spring grippers
• Fine motor training: Pegboard, coin sorting, pinch dynamometry
• Functional task training: Writing, typing, dressing, buttoning
• Constraint-induced movement therapy: If significant recovery has occurred