An adult falls from a height, grabbing an overhead support with an outstretched arm. He now has a claw hand with intrinsic muscle wasting and sensory loss along the medial forearm and hand. He also has ptosis, miosis, and anhidrosis on the same side of the face. The presence of the facial findings localises the injury to which structure?

• A The median nerve at the brachial fossa
• B The ulnar nerve at the elbow
• C The medial cord distal to the sympathetic contribution
• D The lower trunk of the brachial plexus proximal to the sympathetic fibres joining it ✓

Explanation

Klumpke's palsy is a C8 and T1 lower trunk injury producing a claw hand. When the injury sits proximal to the point where preganglionic sympathetic fibres from the stellate ganglion join the T1 root to ascend as the cervical sympathetic chain, the oculosympathetic pathway is disrupted and ipsilateral Horner syndrome appears. This combination strongly suggests avulsion of the T1 root and carries a worse prognosis for spontaneous recovery than isolated ulnar or median lesions.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.