Erb-Duchenne paralysis
Key points
- Brachial palsy is a paralysis or weakness of the arm caused by damage to the brachial plexus (the collection of nerves around the shoulder).
- Brachial nerve injuries can occur during a difficult delivery.
- A physical exam of the infant may show that the Moro reflex is absent on the affected side.
- If some strength has not returned to the affected muscles by 3-6 months of age, surgery on the nerves may restore it.
Alternative names
Klumpke paralysis; Brachial palsy in newborns; Erb's palsy
Definition
Brachial palsy is a paralysis or weakness of the arm caused by damage to the brachial plexus (the collection of nerves around the shoulder).
Causes, incidence, and risk factors
Brachial nerve injuries can occur during a difficult delivery. For example, it can occur if the infant's head and neck are pulled toward the side as the shoulders pass through the birth canal.
The condition can also be caused by excessive pulling on the shoulders during a vertex delivery (head first) or by pressure on the raised arms during a breech delivery (feet first).
The infant may have varying degrees of arm paralysis:
- Brachial plexus injuries typically affect only the upper arm
- Erb's paralysis affects the upper arm and rotation of the lower arm
- Klumpke paralysis affects the hand (the infant may also have an eyelid droop on the opposite side)
Brachial palsy is less common now that delivery techniques have improved and there is more use of C-sections when needed (where the baby is removed surgically through the abdomen).
Risk factors include a larger than average newborn, shoulder dystocia, and breech delivery.
Arm and shoulder fractures can also affect newborns who have had a difficult delivery. Fractures can cause pseudoparalysis. The symptoms may be very similar, although the long-term outlook is very different.
Symptoms
- Noticed immediately or soon after birth
- Lack of spontaneous movement in the upper or lower arm or hand
- Grip may be decreased on the affected side
- Moro reflex is absent on the affected side
- Normal arm position (arm flexed at elbow and held against body) may be absent or weak on affected side
Signs and tests
A physical exam of the infant may show that the Moro reflex is absent on the affected side. This reflex WILL be present in an infant with pseudoparalysis. (In pseudoparalysis, the infant has a fracture and is not moving the arm because of pain.)
The affected arm may flop when the infant is rolled side to side.
Treatment
A full recovery is expected in most cases. Rarely, the palsy may persist. If some strength has not returned to the affected muscles by 3-6 months of age, surgery on the nerves may restore it. Tendon transfers may also help to compensate for nerves that are not functioning properly.
Written and revised by
David Cohen, M.D.
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