Erbs Palsy

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<Index>

 

Definition

-  Upper brachial plexus palsy effecting C5 & C6 +/- C7

 

Features

-  Most common birth related neuropraxia

-  Effects 0.1-0.2% of live births

-  80-90% birth injuries fully recover

-  May take up to 2yrs+

-  Involves axillary, musculocutaneous & suprascapular nerves

-  Most commonly effects supraspinatus & infraspinatus muscles

-  +/- deltoid, biceps, brachialis & subscapularis muscles

 

Risk Factors

-  Difficult delivery

-  Shoulder dystocia

-  Macrosomia

-  Breech

-  Labour dystocia

-  Instrumental deliveries

-  Cervical rib

 

DDx

-  Clavicle fracture

-  Humerus fracture

 

Associated S/S

-  Weakness or paralysis

-  Abduction/elevation of shoulder

-  Elbow flexion

-  Numbness

-  Horners syndrome

-  Preganglionic (worse prognosis)

-  Contractures >6/12

 

 

 

Ix

-  X-ray Upper extremity

-  Clavicle fracture

-  Humerus fracture

 

Mx

-  Regular R/V for improvement

-  Physical therapy: gentle ROM

-  +/- Surgery

-  Exploration to assess prognosis if nil improvement by 6/12

-  Nerve grafting

-  Contracture release

 

 

 

References

 

Wheeless Textbook of Orthopaedics, 10/04/2012

Pics: orthoinfo.aaos.org/topic.cfm?topic=a00077