An adult falls from height, catching a branch with an outstretched hyperabducted arm. She has clawing of all fingers, intrinsic wasting of the hand, and ptosis with miosis on the same side. The associated autonomic finding indicates injury to which structure?

• A Preganglionic sympathetic fibres of T1 ✓
• B Posterior cord of the brachial plexus
• C Long thoracic nerve
• D Stellate ganglion only, sparing the plexus

Explanation

Klumpke palsy is a C8 and T1 lower trunk injury producing an intrinsic minus clawed hand. When Horner syndrome accompanies it, the injury extends to preganglionic sympathetic outflow from T1, which ascends to the superior cervical ganglion. This finding implies a preganglionic root avulsion, carries a poor prognosis for spontaneous recovery, and changes management toward early exploration or transfer rather than observation.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.