An adult involved in a motorcycle accident presents with an ipsilateral claw hand and ptosis, miosis and anhidrosis of the same side of the face. Which structure is injured?
- A Upper trunk of the brachial plexus
- B Lower trunk of the brachial plexus with sympathetic chain involvement ✓
- C Posterior cord of the brachial plexus
- D Middle trunk of the brachial plexus
Correct answer: B. Lower trunk of the brachial plexus with sympathetic chain involvement
Explanation
Klumpke's paralysis involves the lower trunk (B8, T1), damaging the intrinsic muscles of the hand and producing clawing. When the T1 preganglionic fibers carrying sympathetics to the head are also injured, an ipsilateral Horner's syndrome appears, which signals a preganglionic lesion and carries a poor prognosis for spontaneous recovery. The upper trunk gives Erb's palsy; the posterior cord gives radial and axillary deficits without ocular signs.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.