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Three types of lesion result from indirect violence: the whole plexus; the upper-arm type; and the lower-arm type. When the whole plexus is involved, sensibility is lost over the entire forearm and hand and over the lateral surface of the arm in its distal two-thirds.
The lower-arm type of paralysis, associated with the name of Klumpke, is usually due to over-stretching of the plexus, and especially affects the anterior branch of the first dorsal nerve. In typical cases all the intrinsic muscles of the hand are affected, and the hand assumes the claw shape.
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