<prompt> Which of the following is not true about Klumpkes paralysis -Involves lower trunk of brachial plexusIntrinsic muscles of hand are paralysedClaw hand is a featureHorners syndrome can never be associated  <response>: Ans. is d i.e., Horners syndrome can never be associated Klumpkes paralysis: Site of injury: Lower trunk of the brachial plexus Cause of injury : Undue abduction of the arm, as in clutching something with the hands after a fall from a height,or sometimes in birth injury. Nerve roots involved: - Mainly T1 and partly C8. Muscles paralysedi Intrinsic muscles of the hand T1ii Ulnar flexors of the wrist and fingers C8.iii Deformity position of the hand. Claw hand due to the unopposed action of the long flexors and extensorsof the fingers. In a claw hand there is hyperextension at the metacarpophalangeal joints and flexion at theinterphalangeal joints. Disabilityi Claw handii Cutaneous anaesthesia and analgesia in a narrow zone along the ulnar border of the forearm and hand.iii Horners syndrome if T1 is injured proximal to white ramus communicans to first thoracic sympathetic ganglion. There is ptosis, miosis, anhydrosis, enophthalmos, and loss of ciliospinal reflex-may be associated. This is because of injury to sympathetic fibres to the head and neck that leave the spinal cord through nerve Tl.iv Vasomotor changes: The skin area with sensory loss is warmer due to arteriolar dilation. It is also drier due to the absence of sweating as there is loss of sympathetic activity.v Trophic changes: Long standing case of paralysis leads to dry and scaly skin. The nails crack easily withatrophy of the pulp of fingers. 