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Obstetricalal Palsy: Lower Root Injury: (Klumpke)

- See: Obstetrical Paralysis:

- Discussion:
    - injury to the lower roots (C8  and T1 ) & or C7;
    - may follow forceful abduction of shoulder, produces weakness in intrinsics of hand as well as long flexors & extensors of the fingers;
    - these lesions are usually preganglionic;
    - look for an associated Horner's syndrome;
    - sensory deficit is along the medial aspect of the arm, forearm, hand;

- Characteristics of Lower Cord Injuries:
    - C4-C7  roots are well secured to their respective vertebrae & are less prone to avulsion areas;
    - C8 and T1  roots are not well secured;
    - T1 level preganglionic injuries often include a Horner's syndrome due to disrupting the first sympathetic ganglion;
    - traction injuries are most common at C5 and C6  levels;
    - proximal cord lesions will injure supraclavicular branches + distal plexus and will lead to winging of scapula; (see long thoracic)