Klumpke's Palsy Following Minor Trauma: A Rare Presentation in a Young Adult

The brachial plexus is a complex network that transmits motor and sensory signals between the spinal cord and the upper limbs. Klumpke's palsy, a rare injury affecting the lower brachial plexus (C8-T1 roots), commonly occurs in newborns or adults after severe trauma and is characterized by a claw-hand deformity, sensory loss along the medial forearm and hand and weakness in the small muscles of the hand. Adult-onset Klumpke's palsy following minor trauma is exceptionally rare. We report a unique case of isolated right-sided Klumpke's palsy in a 31-year-old male after a trivial fall from bed. Nerve conduction studies confirmed the diagnosis, showing reduced compound muscle action potentials and absent F-wave responses in the right median and ulnar nerves, consistent with a postganglionic lesion in the lower brachial plexus. A previously healthy 31-year-old man presented with two months of pain, numbness and tingling in his right forearm and hand following a minor fall. He experienced difficulty grasping objects, weakness and claw hand deformity. Examination revealed reduced motor strength in wrist and finger muscles, decreased sensation in C8-T1 dermatomes and hypothenar atrophy, with preserved reflexes and intact cranial nerves. Electrophysiological tests showed absent CMAP in the right ulnar nerve and reduced CMAP in the right median nerve, with no F-waves detected, while sensory conduction was normal. The patient received conservative treatment through a multidisciplinary approach. Physiotherapy focused on range-of-motion exercises, strengthening unaffected muscles, using splints to reduce claw deformity, gabapentin for neuropathic pain and NSAIDs for inflammation and nerve conduction studies were scheduled every three months to monitor recovery. The patient reported prior upper arm compression from a tight bandage, which may have contributed. This case emphasizes the importance of considering lower brachial plexus injury after minor trauma and highlights the key role of electrophysiological diagnosis.