II. Epidemiology
- Injuries may occur intrapartum prior to delivery: 50%
- Unrelated to Shoulder Dystocia or excessive traction
- Possibly from fetal Shoulder against Symphysis Pubis
- May be unavoidable
- Reference
III. General
- Follows difficult or prolonged delivery
IV. Mechanism of injury
- Upper plexus Injury
- Lateral flexion of neck against fixed head, Shoulder
- Lower plexus Injury
- Arm forced upward
V. Types
- Duchenne-Erb Paralysis (Waiter's Tip Deformity)
- Klumpke's Paralysis (Clawhand Deformity)
- Whole Arm Paralysis (uncommon)
- Limb completely flaccid
- Hands dry and atrophic
- All reflexes absent
VI. Signs: General
- Arm motionless at side with elbow extended
- Moro Reflex absent on affected side
- Swelling above clavicle due to Hemorrhage
-
Traumatic neuritis
- Tenderness to palpation
- Thoracic root injury
VII. Differential Diagnosis: Pseudoparalysis
VIII. Associated Conditions
- Phrenic Nerve palsy from Birth Trauma
- Horner's Syndrome
IX. Radiology: XRay Shoulder and XRay arm
- Assess for concurrent Fracture
X. Management
- Prevent fixed soft tissue contractures
- Gentle repetitive range of motion Shoulder and elbow
- Supportive splints for wrist and fingers
- Reconstructive surgery for late deformities
XI. Prognosis
- Improvement in first week suggests full recovery
- No improvement by 6 months suggests permanent deficit
- No improvement expected after 2 years
- Older patients
- Underdevelopment of Upper extremity
- Humerus shortened
- Contractures and disuse atrophy
XII. Resources
- The National Brachial Plexus, Erb's Palsy Association
XIII. References
- Behrman (2000) Nelson Pediatrics, Saunders, p. 491-2
- Alfonso (2000) Semin Pediatr Neurol 7(1):4-14 [PubMed]
- Van Heest (1996) Pediatr Clin North Am 43(5):1113-33 [PubMed]