Paralysis can occur from birth. Such as birth paralysis of the brachial plexus or known as Erb palsy. It is named by that term because it was first described by a doctor named Wilhelm Erb.
Erb’s palsy can occur as a result of an injury sustained during birth or later in life. In infants, the condition is most often present at birth. Some cases resolve on their own, but a healthcare provider may recommend exercises to help prevent permanent stiffness.
Definition
Erb’s palsy is also known as Erb-Duchenne palsy. Erb’s palsy is a nerve condition in the shoulder and arm that causes weakness or loss of muscle function. This condition can occur in both infants and adults. It is usually caused by physical injury during childbirth or by a traumatic force downward on the upper arm and shoulder, damaging the brachial plexus.
The brachial plexus is a group of five nerves that connect the spine to the arm and hand. These nerves allow the shoulder, arm, hand, and fingers to feel and move. If these brachial plexus nerves do not work properly due to stretching or tearing, the condition is called brachial plexus palsy.
Erb’s palsy is the most common type of brachial plexus paralysis. It involves the upper nerves in the plexus. Paralysis is another name for partial or complete loss of muscle function, either weakness or paralysis.
There are four types of brachial plexus injuries:
- Avulsion is when a nerve detaches from the spine and is the most serious type of Erb’s palsy.
- A rupture is when a nerve is torn, but not from the spine.
- A neuroma is when a nerve has been torn and healed but has left scar tissue. The scar tissue puts pressure on the injured nerve and prevents it from conducting signals to the muscles.
- Neurapraxia is when a nerve is stretched but not torn. Neurapraxia is the most common type of brachial plexus injury.
Symptom
Erb’s palsy affects the shoulder, arm, and elbow. The muscles of the hand are generally not affected, but the hand may experience tingling or numbness. Symptoms of Erb’s palsy will vary depending on the type of injury to the brachial plexus nerves.
Signs and symptoms of Erb’s palsy include:
- Loss of feeling in one hand
- Limited arm movement
- Paralysis or weakness in the shoulder, arm and elbow. The child cannot lift the arm away from the body or bend the elbow.
- Numbness or tingling in the arm or hand
- The hand position known as the ‘waiter’s tip’ position. The palms face back, and the fingers are curved.
Reason
Newborns can develop Erb’s palsy during labor. Sometimes, a health care provider must turn a baby’s head to one side during birth to get the shoulder out. The brachial plexus nerves from the neck to the shoulder can be stretched or even torn. Newborns can also develop Erb’s palsy because of the way they lie in the womb during pregnancy and after labor begins.
Meanwhile, quoted from the Cleveland Clinic page , in adolescents and adults, traffic accidents (most often involving motorcycles) are the most common cause of brachial plexus injuries. Other causes of this injury include gunshot or knife wounds, industrial accidents, accidents related to contact sports such as football, surgical complications or tumors. This type of injury is more likely to occur in men.
Risk Factors
Risk factors that can cause Erb’s paralysis in infants include:
Breech birth
Babies born feet first have a slightly higher risk of Erb’s palsy because their arms may be elevated and more easily injured by excess pressure.
Gestational diabetes
If blood sugar is not managed well, the baby may be born larger, making delivery more difficult.
Childbirth or use of inappropriate delivery equipment
During a complicated delivery, the baby may be pulled quickly and forcefully from the birth canal, causing injury to the neck and shoulders.
Big baby or small mother size
Labor may be more difficult if the baby is larger than normal or the mother is very petite.
The second stage of labor lasts more than an hour
A prolonged “pushing” stage may place the baby at greater risk for Erb’s palsy and other brachial plexus injuries.
Frequency of Occurrence
Erb’s palsy occurs in 1 to 2 per 1,000 live births or nearly 12,000 cases per year. It is most common in older babies who need to be pulled out during delivery because of obstructed labor.
Diagnosis
To determine if a baby has Erb’s palsy, the doctor will perform a physical exam to evaluate for arm weakness using advanced diagnostic procedures and technology to effectively diagnose, inform treatment, and monitor the condition. Diagnostic procedures may include:
- Electromyogram (EMG): This test measures the electrical activity of muscles in response to stimulation, as well as the nature and speed of conduction of electrical impulses along nerves. It can confirm the presence of nerve damage and assess its severity.
- Imaging studies: Your doctor may order X-rays, ultrasounds or other imaging tests (MRI or CT scan) to check for damage to the bones and joints of the neck and shoulder.
- Nerve conduction studies: This test measures how well individual nerves can send electrical signals from the spinal cord to the muscles.
Handling
Because most newborns with brachial plexus birth palsy recover on their own, doctors will often recheck the child to see if the nerves are recovering. Nerves grow and heal very slowly; it may take up to 2 years for complete recovery.
According to the American Academy of Orthopaedic Surgeons , here are some treatments that can be done to treat this paralysis.
Non-surgical treatment
Daily physical therapy is the primary treatment method for Erb palsy.
Since babies cannot move the affected arm on their own, parents must play an active role in keeping the joints flexible and the muscles that work fit. A doctor or physical therapist will teach parents how to do exercises with their baby to keep the arm in good condition.
Daily physical therapy and range-of-motion exercises, done as often as possible during the day, begin when your baby is about 3 weeks old. The exercises will maintain range of motion in the shoulders, elbows, wrists, and hands. This will prevent the joints from becoming permanently stiff, a condition called “joint contractures.”
Parents can try to find alternative hydrotherapy that combines exercise with water. Water provides support that makes the exercise less painful.
Surgical care
If there is no change during the first 3 to 6 months, the doctor may suggest surgery on the nerve to improve potential outcomes.
In microsurgery , surgeons often use high-powered microscopes and special tiny instruments. Nerve surgery usually does not restore full normal function, and it is usually not helpful for older babies.
- Nerve grafting . Depending on the nerve injury, it may be possible to repair the rupture by “splicing” a donor nerve graft from another nerve in the child.
- Nerve transfer . In some cases, it may be possible to restore some function in the arm by using a nerve from another muscle as a donor.
Because nerves heal very slowly, it may take months, or even years, for the repaired nerve in the neck to reach the muscles of the forearm and hand. After surgery, the doctor or physical therapist will give you rehabilitation exercises to do at home to improve your baby’s strength and range of motion.
Other procedures
Other surgical options to treat brachial plexus birth paralysis may include:
- Joint contracture release . Thickened soft tissue around the shoulder and elbow joints can be released to allow more movement.
- Tendon transfer . To improve the ability to lift the arm, the functioning tendon is moved from its normal attachment in the body and reattached in the shoulder area.
Mental support
In some children, the affected arm appears smaller than the unaffected arm. This is because the nerves do affect growth. Although the affected arm will continue to grow as the child grows, it will grow at a slower rate, and the difference in size will become more noticeable as the child gets older.
Children are very adaptable. Be supportive and encouraging, and focus on all the things your child can do. This will help your child develop a healthy sense of self-esteem and compensate for any functional limitations.
Possible Complications
According to a study published in StatPearls Publishing in 2022, neglected cases can cause 20% to 30% of permanent deficits in nerve function. Persistent Erb palsy can also affect a child’s quality of life and self-esteem.
Many long-term complications of Erb palsy due to nerve damage are:
- decreased strength and stamina
- Abnormal joint movement and function
- muscle atrophy
- bone growth disorder
- osteoarthritis
- leg length difference
- balance and coordination disorders.
Prevention
Most cases of Erb palsy in babies can be prevented by:
Advanced planning
If the baby is larger than normal or in the wrong position in the weeks leading up to the due date, advanced planning by the obstetrician to prevent Erb palsy should include ensuring qualified personnel are present in the delivery room, proper use of delivery instruments and extractors, and induction of labor or cesarean delivery if multiple risk factors are identified.
Maternal health care
Good maternal health care during pregnancy, including avoiding or controlling diabetes, can help prevent Erb’s palsy.
That is some information related to Erb palsy which can cause muscle weakness or paralysis in the limbs.
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Republished with permission from theAsianParent Indonesia
