Introduction:
At Physio Needs Academy, we are dedicated to providing compassionate support to families dealing with Erb’s Palsy—a type of brachial plexus injury. Our mission is to shed light on Erb’s Palsy, offer guidance on its management, and ensure the best possible outcomes for affected individuals.
Understanding Erb’s Palsy:
Erb’s Palsy is a condition characterized by the paralysis of muscles responsible for upper arm movement and rotation. It predominantly results from injuries to the upper part of the brachial plexus, mainly affecting the C5 and partly the C6 nerve roots. Often referred to as obstetrical palsy, it is commonly observed in neonates following challenging births.
Causes of Erb’s Palsy:
The primary cause of Erb’s Palsy in neonates is undue separation of the head from the shoulder during birth. Several obstetrical factors can contribute to this condition, including:
- Shoulder dystocia
- Large birth weight and/or maternal diabetes
- Breech presentation
- Prolonged second stage of labor
- Assisted delivery
- Intrauterine torticollis
- Fractured clavicle
Clinical Presentation:
Erb’s Palsy presents with distinct clinical signs:
- The affected arm hangs by the side, adducted, and internally rotated.
- The forearm is extended and pronated, resembling a “policeman’s tip hand.”
- Reflexes such as biceps and supinator jerks are lost.
- Functional limitations include the inability to reach and grasp objects and perform tasks requiring bilateral manual dexterity.
Epidemiology:
The incidence of brachial plexus birth palsy (BPBP) in the US is approximately 0.8-1 per 1,000 births, with Erb’s Palsy accounting for approximately 45% of BPBP cases. Permanent impairment occurs in 3-25% of cases, with recovery in the first few weeks serving as a prognostic indicator. Timely intervention within the first two weeks of life is crucial for favorable outcomes.
Mechanism of Injury:
Erb’s Palsy commonly results from excessive lateral traction or stretching of the baby’s head and neck during delivery, often associated with shoulder dystocia. Compression of the brachial plexus can cause stretching and tearing. Obstetrician-applied traction force and the natural expulsive force of the uterus are key contributing factors.
Diagnosis:
Diagnosing Erb’s Palsy involves a comprehensive assessment, including:
- Gathering a history of complicating factors during pregnancy and delivery.
- Physical examination to identify decreased or absent movement in the affected arm.
- Neurologic examination to assess muscle power, sensation, and reflexes, including the absence of the Moro reflex in the affected arm.
- Possible evaluation for the presence of cervical rib, which can be a risk factor.
Management and Interventions:
The management of Erb’s Palsy includes both conservative and surgical approaches.
Physiotherapy Management:
Physiotherapy plays a pivotal role in Erb’s Palsy management, focusing on:
- Preventing fixed deformities during the first 6 months.
- Range of motion (ROM) exercises.
- Muscle strengthening exercises.
- Educating parents on maintaining ROM and muscle fitness.
- Sensory stimulation.
- Provision of splints.
- Constraint-induced movement therapy (CIMT) and other relevant interventions.
Surgical Management:
Surgery may be considered if conservative treatments prove ineffective or if there is no clinical or electromyography (EMG) evidence of biceps function by six months. Surgical options may include nerve transplants, subscapularis releases, and latissimus dorsi tendon transfers.
Prognosis:
The prognosis depends on the severity of the injury, the timing of treatment, and associated factors. Early intervention yields better results, with approximately 70%-80% of patients experiencing complete resolution within the first year of life.
Differential Diagnosis:
Erb’s Palsy should be distinguished from other conditions such as clavicular fractures, osteomyelitis of the humerus or clavicle, and septic arthritis of the shoulder.
Conclusion:
At Physio Needs Academy, we are committed to empowering families with knowledge and support to effectively manage Erb’s Palsy. Timely intervention, physiotherapy, and, when necessary, surgical options can make a significant difference in the lives of those affected by this condition. Our aim is to provide compassionate care and guidance throughout the journey of Erb’s Palsy, ensuring brighter and more hopeful outcomes.