Brachial plexus palsy, also known as Erb's palsy, is a paralysis or weakness of the arm caused by an injury to one or more nerves that control and supply the muscles of the shoulder and upper extremities (upper brachial plexus). It is more commonly seen in newborns (neonates) and is often the result of a difficult delivery. When it occurs in adults, the cause typically is an injury that has caused stretching, tearing or other trauma to the brachial plexus network. The brachial plexus is the network of nerves that conducts signals from the spine to the shoulder, arm, and hand.
There are four types of brachial plexus injury, avulsion, the most severe type, in which the nerve is ripped from the spine, rupture, in which the nerve is torn but not at the point at which it is attached to the spine; neuroma, in which the nerve is torn and has tried to heal but scar tissue has grown around the site; and neuropraxia (stretch), the most common form of injury, in which the nerve has been damaged but not torn.
Brachial plexus palsy is a paralysis of the shoulder and upper part of the arm. It is most often seen in newborns. This disorder is characterized by an abnormal positioning (adduction) and internal turning of the shoulder with forearm rotation. This rotation causes the hand to be turned downward (pronation). On the affected side, there may also be paralysis of the diaphragm, a loss of feeling and a wasting of the muscles (atrophy). The wrist and hand are usually not affected by any loss of feeling or function.
The disorder is usually spotted at birth or shortly thereafter. One or more members of the delivery team will notice that the newborn does not move the upper or lower parts of the arm or hand on the affected side. The grip of newborn on the affected side will be noticeably weaker than the grip on the unaffected side. The startle reflex (Moro Reflex) will not be present on the affected side. Finally, the infant’s arm will be held awkwardly compared to normal carriage; on the affected side, the arm will not easily assume the normal position with the arm held against the body and bent at the elbow.
Other symptoms of those affected include a limited active range of motion of the entire arm or part of the arm, limpness, weakness of the affected muscles, lack of sensation in the arm or hand, and poor weight-bearing ability of the arm.
Brachial plexus palsy is an injury to the nerve roots and surrounding nerves of the upper brachial plexus. This type of nerve injury may be caused by abnormal stretching (traction) of the shoulder during a difficult delivery such as when the buttocks present first. Sometimes, the injury occurs in the course of an otherwise normal delivery when there is excessive sideways movement of the neck.
Newborns may present with varying kinds of paralysis. Brachial plexus injuries primarily affect the upper arm, while Erb’s paralysis affects both the upper arm and the rotation of the lower arm and hand. A related condition, known as Klumpke paralysis, affects the hand on the affected side and is caused by injury to the lower trunk nerves.
Among adults, these injuries may occur as a result of trauma from automobile accidents, sports injuries, or occasionally even puncture wounds, including animal bites.
Brachial plexus palsy is an uncommon disorder that affects males and females in equal numbers. It is most often seen in newborns, but injuries caused by abnormal stretching of the shoulder may cause brachial plexus palsy at any age. The incidence is estimated at 1 per 2,000 live births.
Treatment of brachial plexus palsy usually consists of physical therapy and splinting of the affected area. Improvement is usually rapid, but in some cases surgery may be necessary to repair the damaged nerves. Other treatment is symptomatic and supportive.
It is important to initiate evaluation and, if necessary, treatment as soon as possible. Infants whose injury occurs at birth may be seen by a physical or occupational therapist during the first few weeks of life.
In many cases, recovery is complete. The location and type of injury are important in determining the extent of recovery.
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FROM THE INTERNET
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