Erb's Palsy
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Erb's Palsy, also known as Brachial Plexus Paralysis, is a condition which mainly due to birth trauma can affect 1 or all of the 5 primary nerves that supply the movement and feeling to an arm. The paralysis can be partial or complete; the damage to each nerve can range from bruising to tearing. Some babies recover on their own; however, some may require specialist intervention.
Signs & Symptoms
Erb's Palsy is usually the result of delivery in shoulder dystocia. Shoulder dystocia is an obstetric emergency (1% of vaginal births) defined by the impaction of the baby's anterior shoulder against the mother's symphysis pubis. Delivery may require great force to be applied to the head in the form of forceps, ventouse cap etc to deliver the baby. This traction increases the head-shoulder interval, so streching the ventral nerve roots of the cervical spine. In some cases it causes avulsions. The most common avulsion is at Erb's point - an area in the antereolateral neck (roughly corresponds to the roots C5 + 6) which damages the nerves supplying the ipsilateral upper limb & shoulder girdle. The muscles affected most are those supplied by Cervical roots 5+6; Axillary, lateral pectoral, upper+lower subscapular, suprascapular and partial paralysis of Musculocutaneous & the long thoracic. This results in loss of rotator cuff function (supplied by Axillary, lower+upper subscapular & suprascapular), deltoid and the triad of arm flexors (Brachialis, Choracobrachialis & Biceps Brachii). This manifests itself as a flaccid paraylsis know as the "Waiter's tip deformity", characterised by;
- Loss of shoulder function (hangs loosely by side)
- Loss of arm flexion
- A pronated arm (Biceps non-functional)
- Hand in pinch grip position
Treatment
Neonatal / paediactric neurosurgery is often required for avulsion repair. Lesions may heal over time and function return. Physiotherapy is often required to regain muscle usage.
Although range of motion is recovered in many children under one year in age, individuals who have not yet healed after this point will rarely gain full function in their arm and may develop arthitis.
Famous People
A famous person afflicted by Erb's palsy was Wilhelm II of Germany.
Also, Martin Sheen was injured during birth and developed the condition in his left arm. His difference in arm length and range of motion can be seen in his movies, especially Apocalypse Now.
See also
References
[Erb's Palsy Group][NINDS]
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