Erb-Duchenne Palsy

Complied by:
Ashiela Nahda Kemala
1102014043

Advised by:
dr. Donny H. Hamid, SpS

Clinical Rotation in Neurology Department of RSUD Pasar Rebo

Period of September 10th – October 13th 2018
 Definition
• Brachial plexus birth palsy is a
neuromotor flaccid paralysis
secondary to injury to one or
several brachial plexus roots
occuring during delivery.
• The term ‘Erb-Duchenne palsy’
or the Upper Trunk palsy refers
to the proximal brachial plexus
roots that involves: C5-C6, and
occasionally C7.
Anatomy

Taken from McNamara, B. (2003). The

Brachial Plexus. Anatomy Primer. 3:28-29.
“Randy Travis Drinks Cold Beverages”
Taken from McNamara, B. (2003). The Brachial Plexus. Anatomy Primer. 3:28-29
Taken from Abid A. (2015). Brachial plexus birth palsy. Management
during the first year of life. Orthopaedics & Traumatology. 5:1-8.
Types of Lesions
Classification of Neonatal Brachial Plexopathies
Group Level Clinical Deficit

I C5-6 Paralysis of shoulder and biceps

II C5-7 Paralysis of shoulder, biceps, and

forearm extensors
III C5-T1 Complete paralysis of limb

IV C5-T1 Complete paralysis of limb with

Horner’s Syndrome

Taken from Darras BT, Jones HR, Ryan MM et al. Radiculopathies and plexopathies In: Neuromuscular Disorders of
Infancy, Childhood, and Adolescence: A Clinician’s Approach 2nd ed. 2015:210.
 Epidemiology
• The incidence of brachial plexus birth palsy varies greatly
between series and is estimated between 0.04 and 0.4% of
live births.
• The frequency of the anterior left occipitoiliac presentation,
which places the right shoulder under the maternal pubis,
explains the predominance of these lesions on the right side.
• In 4% of cases,the lesions can be bilateral. Proximal C5C6
paralysis (Erb-Duchenne), by far the most frequent, accounts
for 50–60% of cases.
 Etiology and Pathogenesis
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• Stretching of the brachial plexus during delivery
• Two main risk factors: dystocia of the shoulders and
macrosomia

The causes are probably multifactorial, including excessive

maternal weight gain and a history of brachial plexus palsy
during a preceeding birth.
 Clinical Characteristic
• The characteristic deformityof the C5-
C6 injury includes winged scapula,
adduction, and medial rotation of the
shoulder.
• When C7 is involved, the elbow is inthe
extension and the forearm is in
pronation,
• and flexed wrist and digits in a waiter”s
tip position
• The deep tendon reflexes of the
affected muscles (biceps, triceps, and
brachioradialis may be absent or
diminished.
 Diagnosis
• EMG: difficult to perform and to interpret in newborn or the
infant.
• MRI of the cervical spine, useful examination in preoperative
planning. Advantage compared to CT-myelography: direct
visualization of the spinal cord and in certain cases the brachial
plexus itself. Non invasive exam.
 Differential Diagnosis
• Physeal injury of the proximal humerus.
• Septic osteoarthritis, much rarer, can also stimulatebrachial plexus
palsy
 Treatment and Management
• Most brachial plexus birth palsies are transient
• Initial management consists of supervised home therapy to maintain
passive range of motion

• Microsurgical Indications: should be undertaken for infants with

global lesion and Horner’s Syndrome
 Prognosis
• Most author agree that brachial plexus lesions are most often
transitory, with 75-95% of cases advancing to complete recuperation
• The final prognosis of brachial plexus birth palsy is directly to the type
of the initial nerve lesions.
Thankyou
References
Abid A. (2015). Brachial plexus birth palsy. Management during the first year
of life. Orthopaedics & Traumatology. 5:1-8.
Darras BT, Jones HR, Ryan MM et al. Radiculopathies and plexopathies In:
Neuromuscular Disorders of Infancy, Childhood, and Adolescence: A Clinician’s
Approach 2nd ed. 2015:210.
Hale, H. B., et al. (2010). Current Concepts in the Management of Brachial
Plexus Birth Palsy. JHS. 35A:322-33.
McNamara, B. (2003). The Brachial Plexus. Anatomy Primer. 3:28-29.
Seddon HJ. (1943). Three types of nerve injury. Brain. 66:238–88.
Sunderland S. (1951). A classification of peripheral nerve injuries producing
loss of function. Brain. 74:491–516.