Erb's palsy
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| Erb's palsy Classification and external resources | |
| Brachial plexus | |
| ICD-10 | P14.0 |
| ICD-9 | 767.6 |
| DiseasesDB | 30827 |
Erb's Palsy (Erb-Duchenne Palsy, Brachial plexus paralysis) is a condition which, mainly due to birth trauma, can affect 1 or all of the 5 primary nerves that supply the movement and feeling to an arm. The palsy can recover fully without intervention, which mostly means surgery.
Cause
The most common cause of Erb's palsy is dystocia, an abnormal or difficult childbirth or labour. For example, it can occur if the infant's head and neck are pulled toward the side at the same time as the shoulders pass through the birth canal [1].
Furthermore, the condition can be caused by excessive pulling on the shoulders during a vertex delivery (head first) or by pressure on the raised arms during a breech delivery (feet first)[1].
A similar injury may be observed in adults or following a traumatic fall on the side of the neck. It can also affect neonates affected by a clavicle fracture unrelated to dystocia.[2]
Presentation
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 furtherest point from the force of traction, therefore, the first/most affected.
The most commonly involved nerves are the suprascapular nerve, musculocutaneous nerve, and the axillary nerve.[3]
Treatment
Some babies recover on their own; however, some may require specialist intervention.
Neonatal / pediatric neurosurgery is often required for avulsion fracture repair. Lesions may heal over time and function return. Physiotherapeutic care is often required to regain muscle usage.
Although range of motion is recovered in many children under one year in age, individuals who have not yet healed after this point will rarely gain full function in their arm and may develop arthritis.
Discovery
The renowned British obstetrician William Smellie is credited with the first medical description of an obstetric brachial plexus palsy. In his 1768 treatise on midwifery, he reported a case of transient bilateral arm paralysis in a newborn after difficult labour.
In 1861, Guillaume Benjamin Amand Duchenne coined the term "obstetric palsy of the brachial plexus" after analyzing 4 infants with paralysis of identical muscles in the arm and shoulder, after publishing his initial findings in 1855.[4][5] In 1874, Wilhelm Heinrich Erb concluded in his thesis on adult brachial plexus injuries that associated palsies of the deltoid, biceps and subscapularis are derived from a radicular lesion at the level of C5 and C6 rather than isolated peripheral nerve lesions.[6]
Famous People
Famous people afflicted by Erb's palsy were Wilhelm II of Germany,[7] Joseph Stalin, Queen Victoria of Britain, and famous Canadian journalist Barbara Frum.
Also, Martin Sheen was injured during birth and developed the condition in his left arm. His difference in arm length and range of motion can be seen in his movies, especially Apocalypse Now.
See also
References
- ↑ 1.0 1.1 A.D.A.M Healthcare center
- ↑ Peleg D, Hasnin J, Shalev E (1997). "Fractured clavicle and Erb's palsy unrelated to birth trauma". Am. J. Obstet. Gynecol. 177 (5): 1038-40. PMID 9396889.
- ↑ Norman/Georgetown clinicalconsiderations
- ↑ synd/946 at Who Named It
- ↑ G. B. A. Duchenne. De l’éléctrisation localisée et de son application à la pathologie et à la thérapeutique. Paris, Baillière, 1855.
- ↑ W. Erb. Ueber eine eigenthümliche Localisation von Lähmungen im Plexus brachialis. Verhandlungen des naturhistorisch-medicinischen Vereins zu Heidelberg, 1874, 2: 130-137.
- ↑ Ober WB (1992). "Obstetrical events that shaped Western European history". The Yale journal of biology and medicine 65 (3): 201-10. PMID 1285448.
External links
- Erb's Palsy Group
- brachial_plexus at NINDS
- Duke Orthopedics erbs_palsy
- Watt AJ, Niederbichler AD, Yang LJ, Chung KC (2007). "Wilhelm Heinrich Erb, M.D. (1840 to 1921): a historical perspective on Erb's palsy". Plast. Reconstr. Surg. 119 (7): 2161-6. doi:10.1097/01.prs.0000260726.74745.b8. PMID 17519716.
Certain conditions originating in the perinatal period (P, 760-779) | |
|---|---|
| Maternal factors and complications | Umbilical cord prolapse - Nuchal cord - Chorioamnionitis |
| Length of gestation and fetal growth | Small for gestational age - Large for gestational age - Premature birth - Postmature birth |
| Birth trauma | Cephalhematoma - Brachial plexus lesion (Erb's palsy, Klumpke paralysis) |
| Respiratory and cardiovascular | Intrauterine hypoxia - Infant respiratory distress syndrome - Transient tachypnea of the newborn - Meconium aspiration syndrome - Pneumomediastinum - Wilson-Mikity syndrome - Bronchopulmonary dysplasia |
| Haemorrhagic and haematological | Hemorrhagic disease of newborn - Hemolytic disease of the newborn - Rh disease - Hydrops fetalis - Kernicterus - Neonatal jaundice |
| Digestive system | Ileus - Necrotizing enterocolitis |
| Integument and temperature regulation | Erythema toxicum |
| Other disorders | Periventricular leukomalacia - Congenital hypertonia - Congenital hypotonia - Congenital rubella syndrome |
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
