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| Erb's Palsy |
Erb's palsy is the result of damage to the set of nerves (brachial plexus) that
controls the muscles and movement of the arms, hands and fingers. The
severity of an Erb's palsy depends on the degree of damage to the nerves.
Brachial plexus injury (Erb's palsy) is usually a birth injury caused by
physical trauma to the newborn during the delivery.
Most injuries to the brachial plexus occur at birth as a result of forcible
traction of the baby in the presence of an obstetrical complication. Brachial
plexus injuries are more often than not the result of traumatic stretching
(lateral traction) of the plexus during the birth of the child. Failure of the
medical provider assisting a delivery to take the necessary precautions and
perform each obstetrical procedure correctly usually underlies the
appearance of an Erb's palsy. In most instances, Erb's palsy is usually a
preventable injury. Obstetrical situations that create conditions that can
cause Erb's palsy include:
The three types of brachial plexus injuries are classified as: (1) 'Stretch
injury' which may spontaneously recover in 1-2 years of age with substantial
recovery of function; (2) 'Rupture injury' when nerves are torn in one or
more places within the brachial plexus and surgery is required to repair such
an injury; and (3) 'Avulsion injury' which is the most severe type of Erb's
palsy caused by nerves of the brachial plexus tear completely off from their
spinal cord origin resulting in a total flaccid arm. Surgery is required to
repair an avulsion type injury. A later complications also resulting in Erb's
palsy results from the formation of a (4) neuroma which is a form of scar
tissue that forms around the site of nerve injury when the nerve attempts to
repair itself. Surgery is required to repair the formation of a neuroma.
Erb's palsy most commonly involves the C5 and C6 nerve roots. Brachial
plexus injuries range from mild neuropraxia with early recovery to complete
disruption with no potential for recovery. Nerve lesions can be pre-
ganglionic or post-ganglionic. Pre-ganglionic lesions are associated with a
worse prognosis. Pre-ganglionic lesions are more common in breech
deliveries. Birth injuries usually produce lesions of the axillary nerve,
musculocutaneous nerve and suprascapular nerve. Muscles most often
paralyzed include the supraspinatous and infraspinatous. In most severely
affected children, the deltoids, biceps, brachialis and subscapular muscles
are also involved. Electromyogram (EMG) helps to distinguish reversible vs.
irreversible nerve injury and helps to map out the anatomy of the injury.
Evidence of biceps function on EMG before 6 months of age are associated
with near normal function.
The extent of nerve damage correlates with degree of the resulting Erb's
palsy. Every child is affected to a different degree depending on the extent
of injury and location of the brachial plexus. Some children would have no
muscle control or sensation in the arm or hand while another would be able
to move the arm but not the hand and/or fingers.
A variation of Erb's palsy which affects the lower nerves of the brachial
plexus is known as 'Klumpke's Palsy' in which injury to the lower roots (C8
and T1 and/or C7) produces weakness intrinsic to the hands and fingers.
Klumpke's palsy is usually a pre-ganglionic lesion with sensory deficit along
the medial aspect of the arm, forearm and hand. Sometimes, Horner's
syndrome can be associated with this type of palsy.
Management of Erb's palsy will depend on the amount of clinical and
electromyographic retained function. Exercise and physical therapy can aid
in the recovery of an Erb's palsy. Surgical intervention is required when
spontaneous and /or assisted recovery is ineffective. Nerve grafting, tendon
transfers, release of subcapsularis and release of contractures are some of
the treatments. Untreated brachial plexus injuries lead to muscle
contractures, arms deformities and risk of subluxation. Surgical therapy is
most effective between 5 and 12 months of age.
Failure of the medical provider assisting a delivery to take the necessary
precautions and perform each obstetrical procedure correctly ( negligence)
usually underlies the appearance of an Erb's palsy. The most common
factors associated with causing an Erb's palsy are:
If your child suffered an Erb's Palsy, the injury may have been diagnosable,
avoidable or preventable, or plainly resulted from a medical provider's
mistake in handling an obstetrical condition, you and your child are entitled
to receive compensation. If your child's condition was the result of medical
negligence, Dr. Borten and the medical malpractice attorneys at Gorovitz &
Borten can help you assert your rights and get the compensation you
deserve.
controls the muscles and movement of the arms, hands and fingers. The
severity of an Erb's palsy depends on the degree of damage to the nerves.
Brachial plexus injury (Erb's palsy) is usually a birth injury caused by
physical trauma to the newborn during the delivery.
Most injuries to the brachial plexus occur at birth as a result of forcible
traction of the baby in the presence of an obstetrical complication. Brachial
plexus injuries are more often than not the result of traumatic stretching
(lateral traction) of the plexus during the birth of the child. Failure of the
medical provider assisting a delivery to take the necessary precautions and
perform each obstetrical procedure correctly usually underlies the
appearance of an Erb's palsy. In most instances, Erb's palsy is usually a
preventable injury. Obstetrical situations that create conditions that can
cause Erb's palsy include:
- Shoulder dystocia
- Large infant for gestational age (over 8 & 1/2 pounds)
- Gestational diabetes' infant
- Excessive weight gain during pregnancy
- Prior obstetrical history of delivering large infants
- Pregnancy beyond 40 weeks
- Prolonged labor
- Abnormal bony pelvis
The three types of brachial plexus injuries are classified as: (1) 'Stretch
injury' which may spontaneously recover in 1-2 years of age with substantial
recovery of function; (2) 'Rupture injury' when nerves are torn in one or
more places within the brachial plexus and surgery is required to repair such
an injury; and (3) 'Avulsion injury' which is the most severe type of Erb's
palsy caused by nerves of the brachial plexus tear completely off from their
spinal cord origin resulting in a total flaccid arm. Surgery is required to
repair an avulsion type injury. A later complications also resulting in Erb's
palsy results from the formation of a (4) neuroma which is a form of scar
tissue that forms around the site of nerve injury when the nerve attempts to
repair itself. Surgery is required to repair the formation of a neuroma.
Erb's palsy most commonly involves the C5 and C6 nerve roots. Brachial
plexus injuries range from mild neuropraxia with early recovery to complete
disruption with no potential for recovery. Nerve lesions can be pre-
ganglionic or post-ganglionic. Pre-ganglionic lesions are associated with a
worse prognosis. Pre-ganglionic lesions are more common in breech
deliveries. Birth injuries usually produce lesions of the axillary nerve,
musculocutaneous nerve and suprascapular nerve. Muscles most often
paralyzed include the supraspinatous and infraspinatous. In most severely
affected children, the deltoids, biceps, brachialis and subscapular muscles
are also involved. Electromyogram (EMG) helps to distinguish reversible vs.
irreversible nerve injury and helps to map out the anatomy of the injury.
Evidence of biceps function on EMG before 6 months of age are associated
with near normal function.
The extent of nerve damage correlates with degree of the resulting Erb's
palsy. Every child is affected to a different degree depending on the extent
of injury and location of the brachial plexus. Some children would have no
muscle control or sensation in the arm or hand while another would be able
to move the arm but not the hand and/or fingers.
A variation of Erb's palsy which affects the lower nerves of the brachial
plexus is known as 'Klumpke's Palsy' in which injury to the lower roots (C8
and T1 and/or C7) produces weakness intrinsic to the hands and fingers.
Klumpke's palsy is usually a pre-ganglionic lesion with sensory deficit along
the medial aspect of the arm, forearm and hand. Sometimes, Horner's
syndrome can be associated with this type of palsy.
Management of Erb's palsy will depend on the amount of clinical and
electromyographic retained function. Exercise and physical therapy can aid
in the recovery of an Erb's palsy. Surgical intervention is required when
spontaneous and /or assisted recovery is ineffective. Nerve grafting, tendon
transfers, release of subcapsularis and release of contractures are some of
the treatments. Untreated brachial plexus injuries lead to muscle
contractures, arms deformities and risk of subluxation. Surgical therapy is
most effective between 5 and 12 months of age.
Failure of the medical provider assisting a delivery to take the necessary
precautions and perform each obstetrical procedure correctly ( negligence)
usually underlies the appearance of an Erb's palsy. The most common
factors associated with causing an Erb's palsy are:
- Obstetrician's lack of experience
- Failure to diagnose a large for gestation infant
- failure to perform an indicated cesarean section
- Failure to diagnose an abnormal labor
- Use of instrumentation or Pitocin to accelerate the delivery of a large
infant - Failure to manage shoulder dystocia appropriately
If your child suffered an Erb's Palsy, the injury may have been diagnosable,
avoidable or preventable, or plainly resulted from a medical provider's
mistake in handling an obstetrical condition, you and your child are entitled
to receive compensation. If your child's condition was the result of medical
negligence, Dr. Borten and the medical malpractice attorneys at Gorovitz &
Borten can help you assert your rights and get the compensation you
deserve.
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(when possible), please contact us by phone, fax or e-mail with your question
or concern.
Telephone: 781-890-9095 - Fax: 781-890-9098
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