Erb-Duchenne palsy is normally caused at birth and is an injury associated with the upper portion of the arm affecting the main group of nerves. The extent of the damage has a great deal to do with the type of treatment necessary for correcting it. Living with Erbs Palsy may result in temporary paralysis that can last only a few months, or require long term therapy and even surgery.
Shoulder dystocia that occurs during childbirth is generally the cause of this type of palsy. When the baby’s head is delivered, but the shoulder is not able to pass through the pelvic bone without being manipulated, shoulder dystocia can result. In most cases it becomes an emergency situation to remove the baby immediately as the umbilical cord is compressed and the situation can become fatal within five minutes.
The condition can also present in adulthood due to a serious fall. If a person falls to one side on the shoulder, head and neck stretching the nerves severely this condition results. Other possible causes are repairing a dislocated shoulder and damage due to a gunshot wound.
There are three nerves most affected which include the axillary nerve, the suprascapular nerve and the musculocutaneous nerve. Damage with respect to each nerve can be either tearing or bruising. Partial or complete paralysis is possible as a result.
The area affected is known as the Erbs Point which is named for Wilhelm Heinrich Erb a German neurologist. There are six nerves that join together at this point. Its location is just above the collar bone and includes all of the nerve fibers that run from the spine through the neck, then through the armpit and arm.
The signs associated with the condition can be anywhere from loss of sensation to complete paralysis due to weakening of specific muscles involved; deltoid, biceps and brachialis. The arm generally cannot be raised and remains in a position of hanging by the side rotated toward the front with the hand facing forward. This positioning is commonly referred to as waiters tip.
There are three common types of treatment including nerve transfers; nerves are taken from an opposite leg, latissimus dorsi tendon transfers and subscapularis releases. Due to possible nerve damage, nerve transplants are generally only done on infants that are less than nine months of age. At present age limitations are not a concern for other procedures.
External rotation is improved by tendon transfer however, due to muscle position following surgery; increased sensitivity is a very common occurrence. Range of motion can be greatly increased with subscapularis releases and this procedure can be done more than once if necessary. There is the possibility of weakening the existing muscle with the surgery being repeated.
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