{"schema":"https://ver.cy/schemas/card/1.0.0","id":"vr.tr.klumpke-paralysis","code":"thing-q2336817","url":"https://ver.cy/models/thing/q2336817/","name":"Klumpke paralysis","alternateNames":[],"kind":"thing","status":"published","version":"0.1.0-research.1","language":"en","classifiers":{"family":"Thing Registry","category":"Information and virtual systems","entryKind":"thing","plane":"INF","domain":["INF.KNW"],"industry":[],"navPath":"","tags":[],"facets":{}},"whatItIs":"Klumpke paralysis is a lower brachial plexus palsy involving predominantly C8-T1 nerve fibres, causing weakness or paralysis chiefly of the intrinsic hand muscles, often with sensory loss along the medial forearm and hand.","purpose":"Enable an agent to recognise a documented Klumpke paralysis pattern, track hand function and recovery, and support clinician-directed assessment and care.","scope":{"in":["Evidence for C8-T1 involvement and the anatomical extent of the palsy","Affected-side hand weakness, sensory disturbance and functional limitations","Onset, injury context and associated sympathetic signs","Diagnostic confidence, competing localisations and investigation findings","Recovery trajectory and clinician-directed rehabilitation or surgical assessment"],"out":["A complete model of all brachial plexus injuries","Isolated ulnar or median neuropathy without evidence of lower plexus involvement","Cervical spinal cord disease or radiculopathy as independent conditions","Obstetric delivery events and adult trauma events themselves","Standalone models of Horner syndrome, rehabilitation procedures or nerve reconstruction"],"boundaries":[]},"distinguishingFeatures":["Require evidence of a lower C8-T1 pattern rather than identifying the condition from hand weakness alone; this anatomical designation is described in [Texas Children's Hospital teaching material](https://www.texaschildrens.org/sites/default/files/uploads/Chris%20Pederson.pdf).","Compare hand impairment with shoulder and elbow function: relative proximal preservation supports an isolated lower palsy, whereas proximal deficits require assessment for broader involvement. [Texas Children's Hospital](https://www.texaschildrens.org/sites/default/files/uploads/Chris%20Pederson.pdf).","Check whether the motor and sensory findings extend beyond a single terminal nerve before distinguishing the palsy from an isolated ulnar or median neuropathy.","Record associated Horner signs without requiring them for recognition or treating them alone as proof of root avulsion; sympathetic involvement can accompany the lower palsy. [Texas Children's Hospital](https://www.texaschildrens.org/sites/default/files/uploads/Chris%20Pederson.pdf).","Distinguish a documented birth presentation from later acquired injury; neither the name nor the hand posture establishes the cause."],"structure":{"bundles":[{"id":"lower-plexus-identity","name":"Lower plexus identity","description":"Establish what the Klumpke label denotes in this record and how well it fits the observed pattern.","layers":[{"id":"syndrome-definition","name":"Syndrome definition","description":"Connect the registered concept with the recorded clinical diagnosis.","findings":[{"id":"diagnostic-label-and-authority","name":"Diagnostic label and authority","description":"Record the exact diagnostic wording, its author and whether it is provisional or established.","questions":[{"text":"What clinical meaning does the diagnosing source assign to Klumpke paralysis?","id":"diagnostic-label-and-authority-q01","kind":"definition"},{"text":"Who applied the diagnosis, when, and on which examination or investigation evidence?","id":"diagnostic-label-and-authority-q02","kind":"provenance"}]}]},{"id":"anatomical-boundaries","name":"Anatomical boundaries","description":"Separate an isolated lower pattern from wider plexus involvement and alternative localisations.","findings":[{"id":"localisation-and-extent","name":"Localisation and extent","description":"Retain the demonstrated distribution and contradictory findings instead of forcing every deficit into C8-T1.","questions":[{"text":"Which motor and sensory findings support lower plexus involvement, and which structures remain unlocalised?","id":"localisation-and-extent-q01","kind":"measurement"},{"text":"What evidence distinguishes this presentation from upper or total plexus palsy, a terminal neuropathy, or a cervical lesion?","id":"localisation-and-extent-q02","kind":"boundary"}]}]}]},{"id":"onset-and-lesion-context","name":"Onset and lesion context","description":"Capture when the palsy began, the proposed mechanism and the structural injury evidence.","layers":[{"id":"onset-and-mechanism","name":"Onset and mechanism","description":"Distinguish the recorded event from a retrospectively inferred cause.","findings":[{"id":"causal-evidence","name":"Causal evidence","description":"Record birth or later onset and any documented traction event; upward arm traction is a described lower plexus mechanism. [Texas Children's Hospital](https://www.texaschildrens.org/sites/default/files/uploads/Chris%20Pederson.pdf).","questions":[{"text":"When was weakness first observed, and was onset at birth, immediately after an event, or progressive?","id":"causal-evidence-q01","kind":"provenance"},{"text":"Which account supports the proposed mechanism, and what alternative explanation remains unresolved?","id":"causal-evidence-q02","kind":"boundary"}]}]},{"id":"structural-injury","name":"Structural injury","description":"Represent structural findings separately from the clinical palsy pattern.","findings":[{"id":"continuity-and-associated-signs","name":"Continuity and associated signs","description":"Keep suspected stretch injury, rupture and root avulsion distinct, recording associated sympathetic findings separately.","questions":[{"text":"What imaging, operative or specialist evidence establishes the affected structure and its continuity?","id":"continuity-and-associated-signs-q01","kind":"provenance"},{"text":"Which sympathetic signs were assessed, on which side, and what interpretation did the clinician document?","id":"continuity-and-associated-signs-q02","kind":"measurement"}]}]}]},{"id":"hand-impairment-and-use","name":"Hand impairment and use","description":"Describe the specific hand deficits and their effect on daily activity.","layers":[{"id":"motor-sensory-pattern","name":"Motor and sensory pattern","description":"Map tested muscles, movements and sensory territories.","findings":[{"id":"mapped-hand-deficits","name":"Mapped hand deficits","description":"Record intrinsic hand and finger movement findings alongside sensory testing, including spared functions and examination limitations.","questions":[{"text":"Which finger and intrinsic hand movements are weak, absent or preserved on an age-appropriate examination?","id":"mapped-hand-deficits-q01","kind":"measurement"},{"text":"Where is sensation altered, which modalities were tested, and how reliable was the examination?","id":"mapped-hand-deficits-q02","kind":"measurement"}]}]},{"id":"posture-and-task-performance","name":"Posture and task performance","description":"Connect hand posture and available motion with practical use.","findings":[{"id":"usable-hand-function","name":"Usable hand function","description":"Separate observed clawing, passive restriction and active weakness, then record their consequences for relevant tasks.","questions":[{"text":"Is abnormal finger posture passively correctable, and which joints have restricted active or passive motion?","id":"usable-hand-function-q01","kind":"measurement"},{"text":"Which age-relevant grasp, pinch or manipulation tasks can the person perform, and with what assistance?","id":"usable-hand-function-q02","kind":"measurement"}]}]}]},{"id":"diagnostic-evidence-and-recovery","name":"Diagnostic evidence and recovery","description":"Organise investigation results and serial observations around localisation and change.","layers":[{"id":"investigation-interpretation","name":"Investigation interpretation","description":"Preserve what each investigation establishes and its stated limitations.","findings":[{"id":"time-anchored-test-evidence","name":"Time-anchored test evidence","description":"Link imaging and electrodiagnostic reports to the clinical question, age and interval since onset.","questions":[{"text":"When was each test performed relative to onset, and what question was it intended to resolve?","id":"time-anchored-test-evidence-q01","kind":"provenance"},{"text":"Which conclusions about localisation or injury severity are explicit in the report, and which remain uncertain?","id":"time-anchored-test-evidence-q02","kind":"boundary"}]}]},{"id":"serial-recovery","name":"Serial recovery","description":"Track changes in nerve-related impairment separately from changes in task performance.","findings":[{"id":"comparable-recovery-observations","name":"Comparable recovery observations","description":"Compare repeated assessments while retaining changes in method, assistance and compensatory movement.","questions":[{"text":"How have the same tested muscles, sensory territories and hand tasks changed between dated assessments?","id":"comparable-recovery-observations-q01","kind":"measurement"},{"text":"Does improved task performance reflect documented motor recovery, compensation, assistance or an unresolved combination?","id":"comparable-recovery-observations-q02","kind":"boundary"}]}]}]},{"id":"care-decisions-and-review","name":"Care decisions and review","description":"Connect the documented palsy to individual functional goals and clinician-owned decision points.","layers":[{"id":"hand-protection-and-rehabilitation","name":"Hand protection and rehabilitation","description":"Represent the prescribed response to weakness, sensory impairment and movement restriction.","findings":[{"id":"individual-hand-care-plan","name":"Individual hand care plan","description":"Record clinician-selected therapy, positioning, orthoses or sensory-protection measures with their functional targets.","questions":[{"text":"Which documented hand deficit or activity goal does each prescribed measure address?","id":"individual-hand-care-plan-q01","kind":"action"},{"text":"What precautions, assistance needs and reassessment criteria accompany the plan?","id":"individual-hand-care-plan-q02","kind":"action"}]}]},{"id":"specialist-decision-points","name":"Specialist decision points","description":"Track referral and reconstruction assessment against the actual lesion evidence and recovery course.","findings":[{"id":"review-and-escalation-ownership","name":"Review and escalation ownership","description":"Store the responsible specialist, planned review date and explicit decision criteria without importing thresholds from other palsy patterns.","questions":[{"text":"Which clinician owns the next decision, by when, and what evidence must be available?","id":"review-and-escalation-ownership-q01","kind":"action"},{"text":"What age-, lesion- and recovery-specific criteria justify continued observation or assessment for an intervention?","id":"review-and-escalation-ownership-q02","kind":"action"}]}]}]},{"id":"evidence-and-external-alignment","name":"Evidence and external alignment","description":"What the world already says about this thing, gathered so the model can be checked against it.","layers":[{"id":"reported-evidence","name":"Reported evidence","description":"Findings from the breadth pass, kept separate from the structural claims.","findings":[{"id":"evidence-confidence-notes","name":"Check these first","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these check these first hold for the sense of Klumpke paralysis this model covers, and on what evidence?","id":"evidence-confidence-notes-q01","kind":"provenance"}]},{"id":"evidence-kinds","name":"Kinds and varieties","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these kinds and varieties hold for the sense of Klumpke paralysis this model covers, and on what evidence?","id":"evidence-kinds-q01","kind":"provenance"}]},{"id":"evidence-identifiers","name":"Identifiers and schemes","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these identifiers and schemes hold for the sense of Klumpke paralysis this model covers, and on what evidence?","id":"evidence-identifiers-q01","kind":"provenance"}]},{"id":"evidence-real-world-use","name":"Real-world use","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these real-world use hold for the sense of Klumpke paralysis this model covers, and on what evidence?","id":"evidence-real-world-use-q01","kind":"provenance"}]},{"id":"evidence-failure-modes-and-hazards","name":"Failure modes and hazards","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these failure modes and hazards hold for the sense of Klumpke paralysis this model covers, and on what evidence?","id":"evidence-failure-modes-and-hazards-q01","kind":"provenance"}]},{"id":"evidence-neighbours","name":"Neighbouring kinds and how to tell them apart","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these neighbouring kinds and how to tell them apart hold for the sense of Klumpke paralysis this model covers, and on what evidence?","id":"evidence-neighbours-q01","kind":"provenance"}]}]}]}]},"agentConduct":{"may":["Explain Klumpke paralysis and its causes, including birth injuries, citing medical sources.","Advise parents to seek assessment when a newborn does not move a hand or arm normally."],"mustNot":["Diagnose the condition in a person or infant.","Assign blame for a birth injury to a named clinician without evidence.","Advise exercises or splints in place of a therapist's plan.","Share a child's medical details without the parents' consent."],"requiresHuman":["Any decision on surgery or therapy.","Statements about fault in a birth-injury claim."]},"ethics":{"considerations":["Birth injuries affect children for life and raise hard questions of fault.","Families deserve accurate information without false hope or blame."],"affectedParties":["Affected infants and children","Parents","Birth attendants"]},"owners":{"steward":"Nobody owns the condition; clinicians answer for each patient's care.","roles":[],"masterSystems":[]},"relations":[{"target":"Q1629731","type":"parent","note":"registry parent class"}],"interaction":{"identity":{"applicability":"required","items":["Vercy registry: vr.tr.klumpke-paralysis","Wikidata: Q2336817 (https://www.wikidata.org/wiki/Q2336817)"]},"properties":{"applicability":"not-applicable","items":["Diagnostic standing: suspected | clinician-diagnosed | disputed | excluded; assessor and date","Affected side: left | right | bilateral | undocumented","Anatomical localisation: C8/T1 root involvement | lower trunk involvement | mixed extent | unresolved; supporting evidence","Lesion continuity: unknown | continuity preserved | rupture documented | avulsion documented; structure and evidence","Onset and elapsed time: onset date or interval; days since onset; age at onset","Hand muscle performance: muscle-specific strength using a named age-appropriate scale; examination date","Sensory distribution: mapped territory, tested modality and finding; untested explicitly recorded","Associated sympathetic findings: present | absent | uncertain | not assessed; individual signs and side","Hand task performance: named grasp, pinch or manipulation task; assistance, success and age-appropriate instrument","Recovery trajectory: improving | stable | worsening | indeterminate; observation interval and compared measures"]},"recognition":{"applicability":"not-applicable","items":[]},"capabilities":{"applicability":"required","items":["Assemble a traceable lower plexus phenotype from examination and investigation records.","Flag evidence inconsistent with an isolated Klumpke pattern for clinician review.","Compare serial hand strength, sensation and task performance.","Identify missing localisation evidence or overdue clinician-specified reassessment.","Prepare a specialist handover linking lesion evidence, elapsed time, functional goals and unresolved questions."]},"hazards":{"applicability":"required","items":["Persistent hand weakness can limit grasp, fine movement and everyday activities.","Sensory loss can increase the likelihood of unnoticed injury to the affected limb.","Muscle imbalance and prolonged weakness can contribute to joint contractures and deformity.","Incorrectly attributing symptoms to Klumpke paralysis can delay recognition of another neurological injury."]},"interfaces":{"applicability":"required","items":["The International Classification of Diseases, Tenth Revision, issued by the World Health Organization, includes P14.1 for Klumpke paralysis due to birth injury."]},"context":{"applicability":"required","items":["Klumpke paralysis is encountered in neurological and rehabilitation assessment of lower brachial plexus injury.","The term supports documentation of hand weakness, sensory changes and functional recovery in birth-related or later injuries."]}},"sources":[{"title":"Wikidata item Q2336817: Klumpke paralysis","url":"https://www.wikidata.org/wiki/Q2336817","note":"identity and sense of the item"},{"title":"Wikipedia: Klumpke paralysis","url":"https://en.wikipedia.org/wiki/Klumpke_paralysis","note":"general description of the item"}],"openQuestions":["Which authoritative definition should govern inclusion of root-level injuries, lower-trunk lesions and mixed lower-predominant plexus injuries under this registry entry?","Which existing Vercy world model, if any, already owns this concept and should receive the registry link?","Which examination instruments and clinically meaningful change thresholds are validated specifically for isolated Klumpke presentations at different ages?","What evidence supports referral timing and reconstructive decision criteria specifically for isolated lower palsy, separately from upper and total plexus injuries?","How accurately do associated Horner signs and investigation findings predict structural severity and functional recovery in birth versus adult presentations?"],"resources":{"spec":"/models/things/publications/thing-q2336817/spec.json"},"provenance":{"origin":"thing registry research (pass 2)","builtFrom":["models/things/publications/thing-q2336817/spec.json"],"providers":["Codex"],"researchStatus":"unreviewed","generatedAt":"2026-09-12T10:47:00Z","builder":"tools/build_cards.py@1.0.0"},"completeness":{"sections":{"classifiers":"filled","whatItIs":"filled","purpose":"filled","distinguishingFeatures":"filled","structure":"filled","agentConduct":"filled","ethics":"filled","owners":"filled","relations":"filled","interaction.identity":"filled","interaction.properties":"not-applicable","interaction.recognition":"not-applicable","interaction.capabilities":"filled","interaction.hazards":"filled","interaction.interfaces":"filled","interaction.context":"filled","sources":"filled"},"notes":{"_gate":"Published through the thing publication gate 1.0 on 2026-10-07T10:10:28+00:00: completeness 1.00; sense: Wikidata description; 2 live sources; review by codex: pass","interaction.properties":"Plane INF: no invented physical properties.","interaction.recognition":"Klumpke paralysis is a neurological condition whose identity requires clinical assessment and cannot be established from visual appearance alone."},"score":1.0}}