Post Title: OBSTETRIC BRACHIAL PLEXUS PALSY (Erb's Plasy)

Erb's palsy or ErbDuchenne palsy is a paralysis of the arm caused by injury to the upper group of
the arm's main nerves, specifically the severing of the upper trunk C5C6 nerves. These form part of
the brachial plexus, comprising the ventral rami of spinal nerves C5C8 and thoracic nerve T1. These
injuries arise most commonly, but not exclusively, from shoulder dystocia during a difficult
birth.Depending on the nature of the damage, the paralysis can either resolve on its own over a
period of months, necessitate rehabilitative therapy, or require surgery.

The paralysis can be partial or complete; the damage to each nerve can range from bruising to
tearing. The most commonly involved root is C5 (aka Erb's point: the union of C5 & C6 roots) as this
is mechanically the furthest point from the force of traction, therefore, the first/most affected. Erb
Duchenne palsy presents as a lower motor neuron syndrome associated with sensibility disturbance
and vegetative phenomena.

The most commonly involved nerves are the suprascapular nerve, musculocutaneous nerve, and the
axillary nerve.

The signs of Erb's Palsy include loss of sensation in the arm and paralysis and atrophy of the deltoid,
biceps, and brachialis muscles. "The position of the limb, under such conditions, is characteristic: the
arm hangs by the side and is rotated medially; the forearm is extended and pronated. The arm
cannot be raised from the side; all power of flexion of the elbow is lost, as is also supination of the
forearm". The resulting biceps damage is the main cause of this classic physical position commonly
called "waiter's tip".

If the injury occurs at age early enough to affect development (e.g. as a neonate or infant), it often
leaves the patient with stunted growth in the affected arm with everything from the shoulder
through to the fingertips smaller than the unaffected arm. This also leaves the patient with impaired
muscular, nervous and circulatory development. The lack of muscular development leads to the arm
being much weaker than the unaffected one, and less articulate, with many patients unable to lift
the arm above shoulder height unaided, as well as leaving many with an elbow contracture.

The lack of development to the circulatory system can leave the arm with almost no ability to
regulate its temperature, which often proves problematic during winter months when it would need
to be closely monitored to ensure that the temperature of the arm was not dropping too far below
that of the rest of the body. However the damage to the circulatory system also leaves the arm with
another problem. It reduces the healing ability of the skin, so that skin damage takes far longer than
usual to heal, and infections in the arm can be quite common if cuts are not sterilized as soon as
possible. This will often cause many problems for children since they often injure themselves in the
course of their childhoods.

The nervous damage is often the most problematic of the side effects to Erb's Palsy, but it is also the
most varying. There have been cases of patients who have lost complete sensory perception within
the arm after procedures whereas they had full sensory perception before. The most common area
for a loss of sensory perception (except where the arm faces a total loss) is that between the
shoulder and the elbow since the nerves which provide information from that area to the brain are
also those first damaged in the initial causative trauma.

BEST PEDIATRIC ORTHOPEDIC SURGEON, child orthopedic doctor in NADIAD, child orthopedic
hospital in Jaipur.

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palsy.html