ERBS PARALYSIS

Eloisa L. Flores MD

1779 - Smellie reported the case of an infant with bilateral arm weakness that resolved spontaneously within a few days after birth. 1870s - Duchenne and Erb described cases of upper trunk nerve injury, attributing the findings to traction on the upper trunk In 1885, Klumpke described injury to the C8T1 nerve roots and the nearby stellate ganglion

Brachial Plexus

Erb's palsy affects nerves arising from C5 and C6. Upper-middle trunk BPP involves nerve fibers from C5, C6, and C7 levels. Klumpke palsy results in deficits at levels C8 and T1, although many clinicians agree that pure C8-T1 injuries do not occur in infants and may be indicative of spinal cord injury (SCI). Total BPP affects nerves at all levels (C5-T1).

Peripheral Nerve Injury

Purely neurapraxic lesions do not affect the axon itself. These lesions generally are reversible and do not leave sequelae. Axonotmetic lesions - disruption of the myelin sheath and the axon, leading to degeneration of the axon distal to the injury. Neurotmetic lesions are the most severe, destroying not only the axon and myelin, but also the supporting structures across a nerve.

Erb's palsy (Erb-Duchenne Palsy)

paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the upper trunk C5-C6 is severed. most common cause is dystocia it can occur if the infant's head and neck are pulled toward the side at the same time as the shoulders pass through the birth canal

Risk Factors

Large birth weight (average vertex BPP, 3.8-5.0 kg; average breech BPP, 1.8-3.7 kg; average unaffected, 2.8-4.5 kg) Breech presentation Maternal diabetes Multiparity Second stage of labor that lasts more than 60 minutes Assisted delivery (eg, use of mid/low forceps, vacuum extraction) Forceful downward traction on the head during delivery Previous child with OBPP Intrauterine torticollis Shoulder dystocia

Signs of Erbs Palsy

loss of sensation in the arm and paralysis and atrophy of the deltoid, biceps, and brachialis muscles. "The position of the limb, under such conditions, is characteristic: the arm hangs by the side and is rotated medially; the forearm is extended and pronated. The arm cannot be raised from the side; all power of flexion of the elbow is lost, as is also supination of the forearm". The resulting biceps damage is the main cause of this classic physical position commonly called "waiter's tip."

Treatment

most newborns with brachial plexus birth palsy recover on their own Daily physical therapy and range of motion exercises, done as often as possible during the day, begin when a baby is about 3 weeks old. The exercises will maintain the range of motion in the shoulder, elbow, wrist, and hand thus preventing joint contracture.