<s>[INST] context: KLUMPKEY'S PARALYSIS:- Lower plexus injury.Caused by undue abduction of the arm as in clutching something with hand after a fall from a height, or sometimes in bih injury. NERVE ROOTS INVOLVED: C8 and T1 nerve roots involved. MUSCLES PARALYSED: Intrinsic muscles of the hand{T1} Ulnar flexors of the wrist and fingers. DEFORMITY AND POSITION OF THE HAND: Claw hand due to the unopposed action of the long flexors and extensors of the fingers. In a claw hand, there is hyperextension at the metacarpophalangeal joints and flexion at the interphalangeal joints. DISABILITY: Biceps and supinator jerks are lost complete claw hand cutaneous anesthesia and analgesia in a narrow zone along the ulnar border of the forearm and hand. HORNER.S SYNDROME: If T1 is injured proximal to white ramus communicans to the 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 fibers to the head and neck that leave the spinal cord through nerve T1. VASOMOTOR CHANGES: The skin area with sensory loss is warmer due to aeriolar dilatation. It is also drier due to the absence of sweating as there is loss of sympathetic activity. TROPHIC CHANGES: Longstanding cases of paralysis leads to dry and scaly skin. The nails crack easily with atrophy of the pulp of fingers. [/INST] question: Klumpkey&;s paralysis affect | options: A: C5 C6 B: C6 C7 C: C8 T1 D: C4 C5 | answer: C </s>