New York Klumpke palsy birth injury claims must generally be filed before the child's 10th birthday under CPLR §214-a and CPLR §208. Public-hospital cases require a 90-day Notice of Claim under GML §50-e. Klumpke palsy is the rare lower-brachial-plexus subtype of birth injury — affecting the C8 and T1 nerve roots that supply the forearm and hand — and was first described by American-born neurologist Augusta Marie Dejerine-Klumpke in 1885 per peer-reviewed pediatric anesthesia literature. Per NIH StatPearls Klumpke Palsy (NBK531500) and consistent peer-reviewed brachial plexus birth palsy literature including POSNA's Brachial Plexus Palsy reference, Klumpke palsy is characterized by a distinctive "claw hand" presentation with finger and wrist flexion, often accompanied by Horner's syndrome (miosis, ptosis, anhidrosis) when the sympathetic chain is also injured. Porter Law Group represents New York families whose newborns suffered preventable Klumpke palsy injuries.
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Klumpke palsy cases are clinically distinct from the more common Erb's palsy and require careful diagnostic differentiation. The injury affects the lower brachial plexus (C8-T1) rather than the upper plexus (C5-C6), produces a clawed hand rather than the "waiter's tip" position seen in Erb's palsy, and is more often associated with severe injury patterns including nerve root avulsion and Horner's syndrome — which carry poor prognosis for spontaneous recovery per peer-reviewed brachial plexus literature. The malpractice analysis turns on (a) the obstetric maneuvers documented during delivery, (b) whether shoulder dystocia was present and how it was managed, (c) whether ACOG Practice Bulletin No. 178 standards were followed, and (d) the timing and severity of the diagnostic workup.
Porter Law Group has recovered more than $500 million for seriously injured clients since 2009, including multiple pediatric recoveries exceeding $8 million for children with permanent birth-related disabilities. Led by Harvard-educated attorney Michael S. Porter, a former U.S. Army JAG Corps Captain with over 20 years of trial experience, the firm retains maternal-fetal medicine specialists, pediatric brachial plexus specialists, pediatric neurologists, and life care planners on every case. Seven of eight partner-level attorneys are recognized by Super Lawyers, a distinction earned by fewer than 5% of New York attorneys.
"Klumpke palsy is one of the most serious brachial plexus presentations because it usually involves the lower nerve roots that are anatomically more vulnerable to severe injury — including nerve root avulsion. When Horner's syndrome is also present, the prognosis for spontaneous recovery is generally poor, and surgical intervention is often required. The chart almost always shows whether the obstetric team's documented maneuvers and forces are consistent with appropriate management."
— Michael S. Porter, J.D., Porter Law Group
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Klumpke palsy is a specific subtype of brachial plexus birth injury affecting the C8 and T1 nerve roots — the lowest nerve roots of the brachial plexus, which supply motor function to the intrinsic muscles of the hand and the wrist/finger flexors, and supply sensation along the medial aspect of the distal upper extremity (the "ulnar" side of the forearm and hand).
Per NIH StatPearls Klumpke Palsy (NBK531500), the typical clinical presentation in neonates is:
Per the Pediatric Orthopaedic Society of North America (POSNA) and consistent peer-reviewed literature, isolated Klumpke palsy (true C8-T1 only) is extremely rare and is much less common than Erb-Duchenne palsy (the more common upper-plexus C5-C6 injury). Most "Klumpke palsy" cases in clinical practice involve total plexus injury (C5-T1) with the C8-T1 features being the most disabling component.
This is the most important diagnostic distinction in brachial plexus birth injury. Per peer-reviewed pediatric brachial plexus literature and Birth Injury Help Center clinical reference:
| Feature | Klumpke Palsy | Erb's Palsy (Erb-Duchenne) |
| Nerve roots affected | C8 and T1 (lower plexus) | C5 and C6 (upper plexus) |
| Anatomic distribution | Forearm and hand muscles; medial arm/forearm sensation | Shoulder and upper arm muscles; lateral arm sensation |
| Classic position | "Claw hand" — finger and wrist flexion | "Waiter's tip" — adducted shoulder, extended elbow, pronated forearm |
| Frequency | Extremely rare in isolated form | More common — most common form of brachial plexus birth palsy |
| Horner's syndrome | More common (sympathetic chain near T1) | Less common |
| Mechanism | Hyperabduction with arm overhead; forced traction with arm raised | Lateral neck traction during shoulder delivery |
| Prognosis | Variable by severity; lower-plexus injuries with nerve root avulsion or Horner's syndrome carry poor prognosis for spontaneous recovery per peer-reviewed brachial plexus literature | Variable by severity; many resolve with conservative management in the first months of life per POSNA |
| First described by | Augusta Marie Dejerine-Klumpke (1885) | Erb (1874) and Duchenne (1872) |
The differential is clinically important because severe Klumpke presentations are anatomically associated with more severe injury patterns. Per peer-reviewed neurology literature, "isolated lower root injury (C8-T1), Klumpke palsy, is extremely rare" — and when it occurs, it often involves the more severe injury patterns (nerve root avulsion, Horner's syndrome) that carry poor prognosis per peer-reviewed brachial plexus literature.
Per the Narakas classification (1987) used in pediatric brachial plexus practice, true Klumpke palsy was not included in the original Narakas grouping; the most severe Narakas Group IV includes C5-T1 involvement with associated Horner's syndrome — and patients with these features have the worst recovery prognosis.
Per NIH StatPearls Klumpke Palsy (NBK531500), the typical mechanism is hyperabduction with arm overhead during delivery — when forced traction is applied to the upper extremity in a position that places maximum tension on the C8-T1 nerve roots. This mechanism is anatomically distinct from the lateral neck traction mechanism that typically produces Erb's palsy.
The recognized risk factors for brachial plexus birth palsy generally, and Klumpke palsy specifically, include:
Per the POSNA reference, the overall cumulative incidence of brachial plexus birth palsy (NBPP) including all subtypes is approximately 0.15% of all births. Per peer-reviewed pediatric anesthesia literature, the incidence is estimated at 1 to 3 cases per 1,000 live births in industrial countries. Klumpke palsy specifically (the C8-T1 subtype) is rarer than these aggregate figures because most NBPP cases are upper-plexus (Erb's) or total-plexus injuries.
The prognosis depends on the severity of the nerve injury and whether Horner's syndrome is present. Per peer-reviewed brachial plexus literature and consistent clinical reference materials:
| Prognostic Feature | Implication |
| Mild neurapraxia (stretch injury, no structural damage) | Conduction block typically resolves in hours to weeks; full recovery expected |
| Axonotmesis (axon damage, sheath intact) | Recovery over months; usually substantial recovery but not guaranteed |
| Neurotmesis (complete nerve disruption) | Spontaneous recovery unlikely; surgical intervention typically required |
| Nerve root avulsion (root pulled from spinal cord) | No spontaneous recovery; complex reconstruction required if any function is to be restored |
| Concurrent Horner's syndrome | Per 2000 peer-reviewed study (PMID 11062575), poor spontaneous return of motor function in total obstetric brachial plexus injury with Horner's syndrome |
Per NIH StatPearls Klumpke Palsy (NBK531500), the typical conservative management approach is exercising supportive muscles and stretching affected muscles to maintain range of motion. If no improvement is seen by 3 to 6 months, surgical intervention is typically considered — including nerve grafting, nerve transfers, and later muscle/tendon transfers.
Per peer-reviewed brachial plexus literature, diagnostic testing (EMG/NCS and MRI) is typically deferred until the child is 3 months of age because spontaneous recovery may still occur during the first months of life. Early consultation with a pediatric brachial plexus specialist is critical — most major medical centers in New York have dedicated brachial plexus clinics.
Klumpke palsy cases turn on whether the obstetric team's documented maneuvers and forces during delivery were consistent with the published standards for managing the high-risk delivery scenarios (shoulder dystocia, macrosomic delivery, breech delivery, instrumental delivery). Six recurring failure patterns establish liability:
Failure 1 — Excessive lateral or downward traction during shoulder dystocia. Per ACOG Practice Bulletin No. 178: Shoulder Dystocia (May 2017), the recognized response to shoulder dystocia is a sequence of maneuvers — McRoberts maneuver, suprapubic pressure, internal rotational maneuvers, delivery of the posterior arm. Excessive lateral or downward traction on the fetal head is not part of the recognized maneuver sequence and is associated with elevated risk of brachial plexus injury. When the chart shows excessive force without progression through the documented maneuver sequence, the case for malpractice is generally strong.
Failure 2 — Failure to anticipate and prepare for shoulder dystocia in high-risk deliveries. Per ACOG PB 178, recognized risk factors for shoulder dystocia include macrosomia (birthweight ≥4,000 g), maternal diabetes, prior shoulder dystocia, instrumental vaginal delivery, and prolonged second stage. Failure to consider cesarean when these risk factors are documented — and the resulting delivery produces shoulder dystocia with Klumpke palsy — can support malpractice liability.
Failure 3 — Inappropriate forceps or vacuum technique producing brachial plexus injury. Per ACOG Practice Bulletin No. 219: Operative Vaginal Birth (April 2020, Reaffirmed 2022), forceps and vacuum require specific prerequisites and procedural standards. Sequential vacuum-then-forceps use is associated with substantially elevated rates of neonatal complications and should not routinely be performed. When vacuum extraction or forceps was used outside ACOG PB 219 prerequisites and Klumpke palsy results, the case for malpractice is generally strong.
Failure 4 — Inappropriate management of breech delivery. Klumpke palsy is historically associated with breech delivery because the arm-overhead mechanism that produces lower-plexus injury can occur during breech extraction. Per ACOG Committee Opinion No. 745: Mode of Term Singleton Breech Delivery (2018), planned cesarean is generally recommended for term singleton breech presentations because of the elevated fetal injury risk in vaginal breech delivery. Failure to offer cesarean for breech presentation — followed by vaginal delivery producing Klumpke palsy — can support malpractice liability.
Failure 5 — Failure to recognize compound arm presentation. Per peer-reviewed ScienceDirect case report (PMID 23810571), compound arm presentation (the fetal arm extended alongside the head during vertex delivery) is a recognized mechanism for isolated Klumpke palsy. Failure to recognize and reduce a compound arm presentation — followed by delivery producing Klumpke palsy — is a recognized basis for malpractice.
Failure 6 — Failure to refer for prompt brachial plexus specialist evaluation. Per peer-reviewed pediatric brachial plexus literature, evaluation by a pediatric brachial plexus specialist within 3 to 9 months of birth is critical for surgical decision-making. Failure to refer the infant for specialty evaluation — particularly when Horner's syndrome or persistent severe motor deficit is documented — can support a separate negligence claim against the pediatric provider for missing the window for optimal surgical intervention.
New York places no statutory cap on damages in medical malpractice or birth injury cases. The pending NY S1608 (2025-2026) Borrello-sponsored bill proposing a $250,000 cap on noneconomic damages remains pending before the Senate Judiciary Committee and has not been enacted.
Future medical and rehabilitation care is the largest category for permanent Klumpke palsy. Children with permanent C8-T1 injury — particularly those with Horner's syndrome or nerve root avulsion — typically require lifelong physical therapy, occupational therapy, surgical interventions including nerve grafting (typically performed at 3-9 months of age), nerve transfers, tendon transfers, and other reconstructive procedures. Lifetime care plans for severe Klumpke palsy can run into seven figures.
Past and future medical expenses for neonatal evaluation, EMG/NCS, MRI, surgical care, and ongoing therapy.
Lost future earning capacity when permanent functional impairment of the dominant hand affects future occupational options. This category can be particularly substantial for Klumpke palsy because the injury affects fine motor function of the hand — which is implicated in a wide range of occupations.
Pain and suffering damages are not capped in New York. Juries consider the permanence of the injury, the child's life expectancy, the loss of normal hand function, and any associated chronic pain.
Wrongful death. Catastrophic Klumpke palsy associated with severe shoulder dystocia complications can rarely result in death from associated hypoxic injury — when this occurs, parents may pursue a wrongful death claim under EPTL §5-4.1 within two years of the death.
Parents' derivative claim. Parents can recover medical expenses they paid on the child's behalf and damages for loss of the child's services — but under their own 2.5-year CPLR §214-a statute, which is not tolled by the child's infancy.
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Porter Law Group's published catastrophic case results include three pediatric birth injury settlements that demonstrate the firm's track record in complex delivery-related injury cases. View all case results →
$8,300,000 Settlement: A premature infant suffered profound permanent disabilities, including cerebral palsy, after physicians failed to properly manage the mother's pre-gestational diabetes. The structured settlement provides lifetime care and therapy funding.
$8,250,000 Settlement: An infant sustained permanent physical and cognitive disabilities after delayed response to fetal distress during labor. Proceeds covered lifetime medical and educational needs.
$8,120,000 Settlement: An infant suffered permanent delivery-related injuries caused by mismanaged labor and delivery. The recovery funded a life-care plan built with the family's physicians and therapists.
Every case is different. Past results do not guarantee future outcomes.
Klumpke palsy claims are medical malpractice cases under CPLR §214-a — and pose a particular timing risk because the lasting deficit may not be apparent until 6 to 18 months of age, by which time the public-hospital 90-day Notice of Claim window has long closed.
| Category of Defendant | Statute of Limitations | Infancy Toll | Effective Deadline | Primary Statute |
| Private hospital / private physician | 2.5 years | Yes — but capped at 10 years from malpractice | Child's 10th birthday in most cases | CPLR §214-a + CPLR §208 |
| Public hospital (NYC Health + Hospitals, SUNY Upstate, SUNY Downstate, Stony Brook, county hospitals) | 1 year and 90 days after Notice of Claim | No — 90-day Notice of Claim NOT tolled by infancy | 90 days from injury to file Notice of Claim | GML §50-e |
| Wrongful death of infant | 2 years from date of death | N/A | 2 years from death | EPTL §5-4.1 |
| Parents' derivative claim | 2.5 years | No — not tolled by child's infancy | 2.5 years from malpractice | CPLR §214-a |
ACT NOW BEFORE YOUR KLUMPKE PALSY CLAIM DEADLINE EXPIRES →
Was Your Baby Diagnosed with Klumpke Palsy in New York?
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1. Request the complete labor-and-delivery and neonatal records. Under Public Health Law §18, you are entitled to your and your child's complete medical records within a reasonable time of a written request. Critical documents include the operative delivery note (especially documenting shoulder dystocia, the maneuvers used, the time elapsed, any compound arm presentation, and any breech features), Apgar scores, the initial newborn examination noting any arm or hand findings, and any pediatric neurology, pediatric orthopedic, or brachial plexus specialist consultations.
2. Document the infant's hand and arm function over time. Photograph and video the affected arm, hand, and fingers during normal activity. Track whether the infant moves the fingers, whether the wrist extends, whether the grasp reflex is intact on the affected side, whether there is a noticeable "claw" position, and whether there is any drooping eyelid or pupil asymmetry on the same side (signs of Horner's syndrome).
3. Pursue prompt evaluation by a pediatric brachial plexus specialist. Per peer-reviewed brachial plexus literature, evaluation within 3 to 9 months is critical for surgical decision-making. Most major NY medical centers have dedicated brachial plexus clinics.
4. Preserve all imaging and EMG/NCS studies. These typically begin at 3 months of age and include MRI of the brachial plexus and electromyography/nerve conduction studies. These are core evidence of injury severity and prognosis.
5. Track milestones and recovery. Keep a dated log of every pediatric, neurology, orthopedic, brachial plexus specialist, and therapy visit. The trajectory of recovery is core evidence of injury severity.
6. Document the physical therapy and any surgical interventions. Frequency of PT, response to PT, surgical interventions performed, and ongoing rehabilitation needs are all components of the eventual life care plan.
7. Act immediately if your child was born at a public hospital. Births at NYC Health + Hospitals facilities, SUNY Upstate, SUNY Downstate, Stony Brook, or any county-run facility require a Notice of Claim within 90 days under GML §50-e. Missing this deadline can bar the claim entirely. The 90-day window often closes before the parents fully understand the diagnosis — making prompt consultation with a birth injury attorney critical.
8. Consult a New York Klumpke palsy birth injury attorney. Porter Law Group offers free consultations on a contingency-fee basis and handles every stage of the case.
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Porter Law Group represents families in Klumpke palsy and related birth injury malpractice cases throughout New York State, with a statewide practice reaching every county and jurisdiction. Our Syracuse headquarters serves Central and Upstate New York, while attorneys travel regularly to downstate courthouses for cases in the five boroughs, Westchester, and Long Island.
Serving Clients statewide, including Klumpke Palsy Birth Injury Lawyer in Syracuse, New York City, Manhattan, Buffalo, Rochester, Albany, Yonkers, White Plains, Utica, Binghamton, Long Island (Nassau and Suffolk Counties), Saratoga Springs, Ithaca.
Wherever your child was injured in New York, call (833) PORTER-9 for a free consultation with an experienced birth injury attorney.
Klumpke palsy is a specific subtype of brachial plexus birth injury affecting the C8 and T1 nerve roots — the lowest nerve roots of the brachial plexus that supply motor function to the intrinsic hand muscles and wrist/finger flexors, and supply sensation along the medial aspect of the distal upper extremity. Per NIH StatPearls Klumpke Palsy (NBK531500) and POSNA's Brachial Plexus Palsy reference, the condition was first described by American-born neurologist Augusta Marie Dejerine-Klumpke in 1885. The classic presentation includes "claw hand" (finger and wrist flexion), decreased sensation along the medial forearm, and sometimes Horner's syndrome (drooping eyelid, constricted pupil, lack of sweating on one side of the face) when the sympathetic nerve chain near T1 is also injured. Isolated Klumpke palsy of C8-T1 only is extremely rare per peer-reviewed neurology literature; most "Klumpke palsy" cases in clinical practice involve more extensive total plexus injury.
The two conditions are clinically distinct subtypes of brachial plexus birth injury affecting different nerve roots. Klumpke palsy affects the lower plexus (C8 and T1) producing a characteristic "claw hand" with finger and wrist flexion, decreased sensation along the medial forearm, and sometimes Horner's syndrome. Erb's palsy (Erb-Duchenne) affects the upper plexus (C5 and C6) producing the "waiter's tip" position — adducted shoulder, extended elbow, pronated forearm. Per peer-reviewed pediatric brachial plexus literature, Erb's palsy is more common than Klumpke palsy and generally has better recovery prognosis. Per Neurology journal peer-reviewed reference, isolated Klumpke palsy is "extremely rare." See our Brachial Plexus practice page for the umbrella practice covering both Klumpke palsy and Erb's palsy.
Horner's syndrome is a specific clinical finding consisting of miosis (constricted pupil), ptosis (drooping upper eyelid), and anhidrosis (lack of sweating) on one side of the face. It results from injury to the sympathetic nerve chain near the T1 nerve root. In Klumpke palsy, Horner's syndrome indicates that the T1 nerve root injury is severe enough to extend to the sympathetic chain, which has important prognostic implications. Per a 2000 peer-reviewed study (PMID 11062575), poor spontaneous return of motor function was found in total obstetric brachial plexus injury both with and without concurrent Horner's syndrome, though Horner's syndrome is generally considered a marker of more severe injury. Per peer-reviewed neurology literature, the most severe brachial plexus birth palsy classification (Narakas Group IV) includes C5-T1 involvement with associated Horner's syndrome.
Per POSNA's Brachial Plexus Palsy reference, the overall cumulative incidence of brachial plexus birth palsy (NBPP) including all subtypes is approximately 0.15% of all births. Per peer-reviewed pediatric anesthesia literature, the incidence is estimated at 1 to 3 cases per 1,000 live births in industrial countries. Klumpke palsy specifically is much rarer because most NBPP cases are upper-plexus (Erb's palsy) or total plexus injuries. Per peer-reviewed neurology literature, "isolated lower root injury (C8-T1), Klumpke palsy, is extremely rare." When a Klumpke-pattern presentation occurs, it often reflects a more severe injury than the more common Erb's palsy because the lower plexus is anatomically more vulnerable to severe injury including nerve root avulsion.
The prognosis depends on the severity of nerve injury. Per NIH StatPearls Klumpke Palsy (NBK531500), conservative management with physical therapy and stretching is the initial approach, with diagnostic testing (EMG/NCS and MRI) typically deferred until the child is 3 months of age because spontaneous recovery may still occur during the first months of life. If no improvement is seen by 3 to 6 months, surgical intervention is typically considered, including nerve grafting, nerve transfers, and later muscle/tendon transfers. The prognosis is generally worse than Erb's palsy because the lower plexus is anatomically more vulnerable to severe injury including nerve root avulsion. Per peer-reviewed brachial plexus literature, the presence of concurrent Horner's syndrome further worsens prognosis for spontaneous motor recovery. Even with surgical intervention, complete recovery of fine motor hand function is often not achieved.
Klumpke palsy is considered medical malpractice when the obstetric team's documented maneuvers or forces during delivery departed from accepted standards. Per ACOG Practice Bulletin No. 178: Shoulder Dystocia, excessive lateral or downward traction on the fetal head is not part of the recognized response to shoulder dystocia and is associated with elevated risk of brachial plexus injury. Per ACOG Practice Bulletin No. 219: Operative Vaginal Birth (April 2020, Reaffirmed 2022), forceps and vacuum require specific prerequisites; sequential vacuum-then-forceps use is associated with substantially elevated complications and should not routinely be performed. Per ACOG Committee Opinion No. 745 (2018), planned cesarean is generally recommended for term singleton breech presentations because of elevated fetal injury risk, and breech delivery is historically associated with Klumpke palsy. The chart documenting the specific maneuvers used and forces applied is the central evidence in Klumpke palsy malpractice cases.
Klumpke palsy birth injury claims are medical malpractice actions under CPLR §214-a, which imposes a 2.5-year statute of limitations. CPLR §208 tolls the deadline during the child's minority but caps the toll at 10 years from the malpractice, meaning most Klumpke palsy cases must be filed before the child's 10th birthday. Deliveries at public hospitals (NYC Health + Hospitals, SUNY Upstate, SUNY Downstate) require a Notice of Claim within 90 days of the injury under General Municipal Law §50-e, and the infancy toll does not extend the 90-day deadline. Klumpke palsy cases pose a particular timing risk because the lasting deficit may not be apparent until the developmental sequelae become clear at 6 to 18 months, by which time the public-hospital 90-day window has long since closed and a motion for leave to serve a late notice of claim under GML §50-e(5) may be required.
Klumpke palsy settlement values vary based on the severity and permanence of the injury. Mild forms with full recovery generally produce no recoverable damages because the injury resolves completely. Moderate permanent functional deficit cases typically settle in the high six to low seven figures. Severe Klumpke palsy with permanent disability — particularly with Horner's syndrome, nerve root avulsion, or requirement for surgical reconstruction — can settle in the seven figures because of the lifetime cost of physical and occupational therapy, multiple surgical interventions, and the lost earning capacity from impaired hand function. New York places no statutory cap on damages in medical malpractice cases. Every settlement of a minor's claim must be approved by a judge at an infant compromise hearing under CPLR §1207, and attorney fees follow the sliding scale in Judiciary Law §474-a: 30% of the first $250,000, 25% of the next $250,000, 20% of the next $500,000, 15% of the next $250,000, and 10% of any amount over $1,250,000.
Michael S. Porter is the founder and managing partner of Porter Law Group, representing New York families in Klumpke palsy, birth injury, medical malpractice, and catastrophic injury cases. A graduate of Harvard University (B.A., 1994) and Syracuse University College of Law (J.D., 1997), Porter served four years as a Captain in the U.S. Army Judge Advocate General's Corps. Selected to Super Lawyers for 14 consecutive years (2012–2025), he holds a 10.0 Superb rating on Avvo and a Distinguished rating from Martindale-Hubbell.
Bar Admissions: New York State Bar | U.S. District Court, Northern and Western Districts of New York
Memberships: New York State Bar Association, Onondaga County Bar Association, New York State Academy of Trial Lawyers, Multi-Million Dollar Advocates Forum
If your newborn suffered a Klumpke palsy birth injury in New York due to medical negligence, critical deadlines may run faster than you expect: public-hospital cases require a Notice of Claim within 90 days, parents' derivative claims are not tolled by the child's infancy, and the 10-year cap under CPLR §208 closes most birth injury windows before a child's 10th birthday.
Contact Porter Law Group today at (833) PORTER-9 for a free, no-obligation consultation. We operate on a contingency-fee basis under Judiciary Law §474-a, so you pay nothing unless you win.
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