Paralysis of the lump. Paralysis Dejerine Klumpke - causes, symptoms and treatment

Birth trauma is a pathological condition characterized by damage to tissues and organs in a newborn during childbirth, which is accompanied by a violation of their functions.

Traumatic injuries become possible when the size of the child does not correspond to the birth canal, during the provision of manual or instrumental assistance or caesarean section. They are also recorded in post-term pregnancy, large fetal mass, malformations of its development, anomalies of presentation, vacuum extraction, narrow maternal pelvis, exostoses, and advanced age of the puerperal.

Paralysis of Dejerine-Klumpke occurs with spinal cord injury at the level of C7-T1 or the middle and lower bundles of the brachial plexus. This results in flaccid paralysis of the distal upper limb. The arm lies along the body, the hand hangs down passively. Independent movements in the wrist and elbow joints are impossible, but they are present in the shoulder joint.

Diagnostics

The clinical diagnosis is obvious, taking into account the data of physical methods of research and the neurological symptom complex. In some cases, an X-ray examination is prescribed.

Treatment of Klumpke's paralysis with birth trauma

The newborn is provided with complete rest, up to the point that they are weaned, and fed by the probe method. Oxygen therapy is carried out, vitamins, glucose, cardiovascular agents, as well as drugs that reduce the excitability of the central nervous system and antihemorrhagic agents are prescribed.

Essential drugs

There are contraindications. Specialist consultation is required.

1. () - a tranquilizer. Dosage regimen: for children, the dosage is always determined individually, taking into account age, level of physical development, general condition and response to treatment. The initial dose is 1.25-2.5 mg per day, divided into 4 doses. This dose can be reduced or increased, taking into account the individual response to ongoing therapy.
2. Vitamin K () is an antihemorrhagic agent. Dosage regimen: appoint 0.5-1 ml of a 1% solution intramuscularly for 3 days with a hemostatic purpose.
3. (a drug that stimulates blood clotting). Dosage regimen: appoint inside 0.5 g 3 times a day. The course of treatment is 3 days.
4. Bendazole () is a drug that improves the function of the central nervous system. Dosage regimen: take orally 0.002 g 2 times a day. The course of treatment is 10 days.
5. (nootropic drug). Dosage regimen: Cerebrolysin is used parenterally in the form of intravenous injections at the rate of 0.1-0.2 ml/kg of body weight. The recommended course of treatment is daily injections for 10-20 days. To increase the effectiveness of treatment, repeated courses can be carried out as long as there is an improvement in the patient's condition due to treatment. After the first course, the frequency of injections can be reduced to 2 or 3 times a week.
6. Hyaluronidase () is a drug with proteolytic activity. Dosage regimen: in case of traumatic lesions of the nerve plexuses and peripheral nerves, it is injected s / c into the area of ​​the affected nerve (64 units in procaine solution) every other day; per course - 12-15 injections. The course of treatment is repeated if necessary.

Paralysis of Dejerine-Klumpke is accompanied by paralysis of the muscles of the hand and forearm, which is caused by injury to the first thoracic and seventh cervical nerves. In the future, the consequences of this injury lead to disruption of the functioning of the deep muscles of the hand, fingers, and wrist flexors. As a result, the patient's fingers and hand stop moving, small muscles atrophy, and the limb may take the form of a "clawed paw" or "seal's foot."

Why does Dejerine-Klumpke palsy occur? What symptoms does it manifest? How is this pathology diagnosed and treated? You will get answers to these questions by reading this article.

Causes

Improper reduction of a dislocated shoulder joint can cause Dejerine-Klumpke palsy.

The most common cause of Dejerine-Klumpke's paralysis is birth trauma. Usually, such a lesion occurs with shoulder dystocia, during which, in the second stage of labor, one or both shoulders of the fetus are retained in the pelvic cavity for more than 1 minute. Such a violation of labor can be caused by a narrow pelvis of the mother or a large fetus. Sometimes injury to the first thoracic and seventh cervical nerves is caused by traction on the baby's arm extended overhead at birth. Dejerine-Klumpke paralysis caused by birth trauma can be combined with fractures of the clavicle or humerus, dislocation of the shoulder joint.

Dejerine-Klumpke paralysis can be provoked not only by birth injuries. The following factors can cause its development:

• a fall from a height, during which a person grabs a branch or other object above his head with his maximum hand;
• compression of the brachial plexus by false ribs or neoplasms;
• gunshot wounds;
• incorrect reduction at;
• primary neuritis of the nerve roots.

Symptoms

The severity of the manifestations of Dejerine-Klumpke paralysis can be variable, since their nature and severity are determined by the degree of injury to the nerve fibers.

With any lesions of the brachial plexus, there is a violation in the work of the muscles of the forearm and hand. Movements in them are completely absent or sharply limited, the affected arm hangs down along the body and sensitivity is disturbed in it (numbness, crawling sensations, etc.). In severe forms of paralysis, movements in the limb are completely absent.

In some patients, due to damage to the sympathetic nervous system, Bernard-Horner syndrome develops, in which the eyelid droops, the eyeball retracts, and the pupil narrows.

When examining the affected hand, the following signs are revealed:

• pale skin with a bluish tint;
• brush flat;
• cooling of the skin in the affected area;
• a brush in the form of a "seal's foot" (with a greater lesion of the radial nerve) or a "clawed paw" (with a greater damage to the ulnar nerve);
• thinning, susceptibility to damage and dryness of the skin;
• anhidrosis or;
• fragility of nails;
• the absence of the Babkin and Robinson reflex (or grasping);
• reduced Moro reflex;
• the motor ability of the shoulder joint is preserved.

Dejerine-Klumpke paralysis that develops in childhood can lead to a curvature of the spinal column ().

Diagnostics

The detection of Dejerine-Klumpke paralysis usually does not cause difficulties, and a visual examination of the patient is sufficient to make a diagnosis. For differential diagnosis, the following studies are prescribed:

• radiography;
• analysis of cerebrospinal fluid;

Treatment

Medical therapy of this disease is supplemented by methods of physiotherapy and massage.

Treatment of Dejerine-Klumpke palsy should begin as early as possible. His tactics is determined by the age of the patient and the severity of the pathology.

The treatment plan may include the following activities:

• immobilization of a limb in a physiological position with a splint;
• taking antibiotics and (in the presence of inflammatory processes);
• neurotrophic drug therapy: injections of B vitamins, dibazol, galantamine, pentoxifylline, nicotinic acid;
• massage;
• physiotherapy;
• physiotherapy procedures: UHF, reflexology, ultraphonophoresis, electrophoresis, mud therapy, balneotherapy.

In most cases, timely and regular conservative therapy can significantly minimize the manifestations of Dejerine-Klumpke's paralysis. In severe injuries of the brachial plexus, surgical treatment may be recommended, which consists in plastic surgery of the nerve trunks of the plexus, the method of which is determined by the clinical case.

Which doctor to contact

If there are violations in the movement of the hand and elbow joint, changes in the shape of the hand and violations of sensitivity, you should contact a neurologist. After examining the patient and conducting a series of studies (X-ray, blood test for syphilis and analysis of cerebrospinal fluid), the doctor will draw up a treatment plan and, if necessary, recommend a consultation with a neurosurgeon.

Dejerine-Klumpke paralysis develops as a result of damage to the first thoracic and seventh cervical nerves and is accompanied by impaired movements in the hand and elbow joint. The severity of its manifestations depends on the severity of injury to the brachial plexus. Often this neurological pathology is the result of birth trauma. Its occurrence always requires timely treatment, which in many cases can significantly minimize the manifestations of paralysis.

Until now, cases of birth traumatism are widespread in pediatric practice. Often this is facilitated by various factors that impede physiological childbirth (multiple pregnancy, etc.). And it is birth trauma that can lead to various neurological manifestations and diseases. An example of such a pathology is the defeat of the lower level of the brachial plexus or the lower Dejerine-Klumpke paralysis.

Information for doctors. Like other lesions of the brachial plexus, Dejerine-Klumpke palsy is coded under the code G54.0 according to the ICD. The diagnosis must indicate the level of damage to the plexus, the direction of localization of the process, the severity of symptoms separately for each of the clinical syndromes.

The immediate cause of the development of the disease is the defeat of the brachial plexus at the level of the lower cervical and upper thoracic roots. The clinical picture depends on the degree of damage and can be variable.

Clinical picture

In all cases, the muscles of the forearm and hand are affected. The symptom of "clawed paw" may form. Bringing the limb to the body is not very pronounced, but also takes place. In some cases, atrophy of the muscles of the forearm develops, dystrophic changes in the nail plates.
Damage to the sympathetic nervous system can lead to the development of ocular manifestations. A child may have a complex of symptoms combined in the Bernard-Horner syndrome: drooping of the eyelid, constriction of the pupil, retraction of the eyeball. At an older age, patients may describe numbness in the hand, crawling, and other paresthetic sensations in the hand on the side of the lesion.

Diagnostics

Diagnosis of the disease is based on the appearance of the patient. Also, for differential diagnosis, it is important to conduct a RMP study for syphilis, sometimes it is possible to conduct an x-ray study, electroneuromyography.

Treatment

Treatment can begin from the first days of birth. Treatment with position, vitamin therapy, neurotrophic treatment is used. In addition, massage of the limbs, regular physical therapy exercises are shown.

In most cases, there is a persistent improvement, sometimes up to a complete cure.

Description:

Named after Augusta Déjerine-Klumpke. Dejerin-Klumpke (Klumpke's palsy) is a type of partial paralysis of the lower branches of the brachial plexus, characterized by peripheral paresis or paralysis of the muscles of the hand, a change in sensitivity in the corresponding zone, vegetative-trophic changes, including pupillary disorders.
The brachial plexus is a network of spinal nerves that exit from the back of the neck, go to the armpit, and supply the upper extremities.

Symptoms:

Symptoms include paralysis of the deep muscles of the hand (muscles of the eminence of the thumb and little finger, interosseous and vermiform muscles), and numbness in the zone of innervation of the ulnar nerve. cover the inner surface of the shoulder, forearm and hand. Involvement of the first thoracic nerve (T1) can lead to Horner's syndrome with ptosis and. This may be in contrast to Erb-Duchene palsy, which occurs due to damage to the fifth (C5) and sixth (C6) cervical nerves.

Causes of occurrence:

Dejerine-Klumpke palsy is a form of paralysis that affects the muscles of the forearm and hand, and is the result of damage to the brachial plexus, namely injury to the seventh cervical (C7) and first thoracic (T1) nerves "before or after they join the nerve trunk lower limb. The subsequent paralysis affects mainly the deep muscles of the hand and the flexors of the wrist and fingers. Trauma to these nerves can occur during childbirth. Most often, paralysis occurs during traumatic childbirth, specifically - shoulder dystocia. The risk of shoulder dystocia increases with a narrow pelvis and a large fetus. The risk of injury to the lower brachial plexus occurs when pulling on the abducted arm, for example, when the child is pulled by the arm during the birth (the arm is extended above the head), or when a person falling from a tree grabs a branch (and the arm is again in the maximum abducted position). Damage to the lower brachial plexus should be differentiated from damage to the upper brachial plexus, which can also be the result of a birth injury, but at the same time give a different syndrome of weakness, the so-called. Erb-Duchene palsy. Also, the cause of Dejerine-Klumpke paralysis can be compression by false ribs or tumors.
However, “the brachial plexus can also be damaged by direct impact, either from a gunshot wound or from the reduction of a dislocated shoulder joint; the severity of the paralysis depends on the severity of the damage to the plexus nerves. In some cases, the injury appears to be a sloughing of the spinal nerve roots from the spinal cord rather than a rupture of the nerve itself, and if this is due to involvement of the first thoracic nerve (T1), then the pupil on that side may be constricted (depending on the degree of damage to the preganglionic fibers that go as part of the first thoracic nerve to the pupil dilator). Paralysis may be due to primary inflammation of the roots, their primary

Synonyms of Dejerine-Klumpke syndrome. S. Klumpke. Paralysis Dejerine-Klumpke. Paralysis Klumpke.

Definition of Dejerine-Klumpke syndrome. Characteristic paralysis of the hand, which develops as a result of damage to the roots of the VII or VIII cervical and I thoracic nerves or part of the neck. Refers to cervico-shoulder syndromes.

Symptomatology of the Dejerine-Klumpke syndrome:
1. Paralysis of the small muscles of the hand, as well as parts of the long articular muscles of the forearm. In this regard, the hand is in the position of a paw or fin, like a seal (Peters).
2. S. (Claude) Bernard-Horner due to a concomitant lesion of ramus communicans of the thoracic vertebrae.
3. Violations of sensitivity in the area of ​​a narrow zone of the inner surface of the forearm (differential diagnostic sign) and the ulnar side of the hand (not always; sometimes there is only a hint of this).
4. In addition, sometimes there are vasomotor-secretory disorders: anhidrosis, hyperhidrosis, ischemia, changes in skin temperature in the area of ​​the hand and forearm.

Etiology and pathogenesis of Dejerine-Klumpke syndrome. Damage to the roots of the VII and VIII cervical and I thoracic nerves, parts of the plexus located here, as well as concomitant lesions of the sympathetic fibers of the ciliospinal center as a result of various kinds of acute traumatic effects on the vertebrae, including contusion.

A similar lesion of the cervical region leads to symptoms of the so-called scalene syndrome.

Differential diagnosis of Dejerine-Klumpke syndrome. Shoulder-hand syndrome. Scalene syndrome. S. Duchenne-Erb (see). S. (M.) Parrot (see).

Brachial plexus - C7-Th1 roots are affected in Dejerine-Klumpke syndrome