Erb's #Palsy - brachial palsy


Erb's Palsy

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The condition known as Erb’s Palsy is caused by an injuryto the brachial plexus—the nerves surrounding the shoulder. Erb’s Palsy is not cerebralpalsy,because it is not caused by brain injury or brain abnormalities. Erb’s Palsy is also called brachial palsy, Erb-Duchenned paralysis, or Klumpke paralysis








Symptomsof Erb’s Palsy 

Erb’s Palsy is characterized byweakness or paralysis of the arm. The disorder causes varying amounts ofimpairment. The levels of impairment are known by some of the other names forthe condition. When the upper arm is the only part of the limb affected, thecondition is simply called a brachial plexus injury.


The condition is designated Erb’sparalysis when it affects moving the upper arm and rotating the lower arm. Ifthe condition affects the hand it is called Klumpke paralysis; this form of thecondition can cause the eyelid to droop on the side opposite to the affectedhand





Causesof Erb’s Palsy

Erb’s palsy is the result of a nerveinjury. All the arm’s nerves are connected to a group of nerves near the neckwhich is called the brachial plexus. The brachial plexus nerves are responsiblefor feeling





and motion in the hand, fingers, and arm. Erb’s palsy canbe caused by several things which can happen during a difficult delivery

Approximately one or two babies perthousand births will have a brachial nerve injury. The brachial nerves can beinjured if the baby’s neck and head are drawn to the side when the shouldersexit the birth canal. Pulling excessively on the shoulders as the baby comesout head first can also lead to a brachial nerve injury. During a breech birth(feet first), the arms are usually raised and may be injured from excesspressure


Improved delivery techniques nowprevent many brachial plexus injuries. Larger than average babies are atgreater risk for this form of injury; larger than average birth weigh is calledmacrosomia and is defined as a birth weight of 8 lb, 13 oz or more. A breechbirth (the baby presenting abnormally—feet first) also puts the baby at greaterrisk of injury





ShoulderDystocia

Larger than average babies areespecially at risk for a problem during delivery called shoulder dystocia. Inshoulder dystocia, the infant’s head is delivered normally, but one shoulderbecomes stuck under part of the mother’s pelvic bones. This is a difficultsituation for doctors to remedy. The mother’s position will be manipulated in anattempt to free the baby’s shoulder and the doctor will also manipulate thebaby within the birth canal. If manipulation and gentle pressure fail, surgerymay be needed


Shoulder dystocia is dangerous to boththe mother and the baby. A delivery in which shoulder dystocia occurs is mostlikely to cause injury to the brachial plexus, resulting in impaired movementof the injured arm. Women who are short or who have had gestational diabetesare at greater risk for the occurrence of shoulder dystocia. So are women withpelvic abnormalities. Prolonged labor also increases the risk


Sometimes shoulder dystocia occurswhen it anticipated that delivery will be normal. The only thing physicians cando help prevent injury in an unexpected situation is simply to be alwaysprepared for an emergency during delivery and to have a medical team familiarwith difficult deliveries on hand during even routine deliveries


Use of forceps or a vacuum extractorshould be avoided if possible during delivery, because use of these methodsincreases the risk of shoulder dystocia. In the case of an extra large baby ora delivery which is expected to be breech, the physician should advise themother and her family of possible problems and what may be needed to safelydeliver the baby





Complicationsof Erb's Palsy

Most cases of Erb’s palsy are due tostretching of the nerve and will heal within six to twelve months of delivery;stretching shocks the nerve, but rarely leaves permanent damage. Occasionally astretch injury will cause scar tissue to form around healthy nerves; in thiscase recovery may not be total.


Cases in which the nerves are torn arethe most serious and will not completely heal on their own. In rare instancesthe nerve is actually torn apart from the spinal cord; this is called anavulsion. It is estimated that fewer than 10% of brachial plexus birth injuriesresult in permanent paralysis or impairment





Ageof Diagnosis

Because Erb’s palsy is caused by aninjury at birth, it is almost immediately apparent. However, the extent of theinjury may not be known for some months after the baby’s birth. Babies withErb’s palsy may lack a Moro reflex on the affected side; the Moro reflex,present in healthy newborns, occurs when the infant is startled. A startlednewborn will throw out the arms to the side with the palms up and the thumbsflexed


A baby with Erb’s palsy may hold theaffected arm tight against the body with the elbow flexed. There may be littlespontaneous movement of the injured arm or hand. There may also be a lack ofstrength in the infant’s grip on the affected side. The affected arm maydevelop more slowly than the healthy arm and may be much smaller





Treatments for Erb's Palsy

In cases of a simple stretch injury ormild tear, Erb’s palsy will heal on its own, but the baby should receivephysical therapy so that the arm does not stiffen. Gentle massage and range ofmotion therapy are used to keep the muscles strong and the joint from becomingcontracted. More extensive nerve damage may require surgery. If the nervescannot function properly, tendon transplants are sometimes used


Such options are generally notdiscussed until the child is three to six months old. Even with surgery, nerveinjuries heal very slowly and it may take two years or more for a completerecovery. In some cases, the affected arm will always be weak; the range ofmotion may also be limited

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