Brachial Plexus RTDCB: Randy Travis Drinks Cold Beer Dermatomes Upper Brachial Plexus Injury Erb-Duchenne Palsy A 33-year-old male presents two weeks following a motorcycle crash with the main complaint of limited functional use of his right arm. Physical exam reveals a right arm that is adducted and internally rotated with some flexion of the wrist. History reveals that during the accident he landed on the upper right shoulder and neck, sustaining significant skin abrasions to the area of his right lateral neck down to his acromion process. Klumpke Palsy Klumpke palsy may produce several abnormal postures. Classically, it produces flexion and supination of the elbow, extension of the wrist, hyperextension of the metacarpophalangeal joints, and flexion of the interphalangeal joints with the claw hand posture. This presentation is rarely seen in the newborn period. Klumpke syndrome usually manifests in the newborn period as weakness restricted to or mainly involving the hand. In many occasions, there are no reflex or spontaneous movements of the intrinsic hand muscles.