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What are the signs and symptoms of Erb’s palsy?

            Every loving couple would look forward to having their own child. Pregnancy and birth labour can be frightening especially for a first-time mother. All parents want the best for their child as providing the best can ensure the bright future for their children. However, in the world of medicine, there are many possibilities that can occur to their child and cause a child to be born or live with certain medical conditions. One of them is Erb’s palsy.

            Erb’s palsy is a form of brachial plexus palsy. Brachial plexus is network nerves near the neck that give rise to all the nerves of the arm. These nerves provide movement and sensation to the shoulder, arm, hand and finger. Thus, Erb’s palsy in general means there is weakness to the arm and loss of motion. Erb’s palsy is named after the name of the doctors who describe the condition, Willhelm Erb.

            Erb’s palsy is also known as Erb-Duchenne paralysis. Specifically, the brachial plexus that is commonly affected are the upper trunk nerve roots of C5 and C6. 1 or 2 of every 1000 babies do have this condition. Erb’s palsy is often caused by injury to the newborn resulting from a difficult childbirth. During the delivery, the infant’s neck is stretched to the. Two major risk factors include shoulder dystocia (baby’s shoulder gets caught above the mother’s pubic bone) and the large size of the fetus.

            In most cases of brachial plexus birth palsy, it revolves around Erb’s palsy with 45%. The infant may be unable to move the shoulder but able to move the fingers. The classical sign of Erb’s palsy is the ‘waiter tip hand’. This means that the arm hangs limply from the shoulder with the forearm rotated to the inside with flexed wrist and finger. Another symptom of Erb’s palsy is the loss of sensation of the arm and shrinkage muscle (atrophy) of the arm muscle such as deltoid, biceps and brachialis. The arm cannot be raised from the side and the elbow is unable to be flexed.

            Since Erb’s palsy can be similar with Klumpke palsy, doctors usually look for a grasp reflex. Klumpke palsy is another form of brachial plexus palsy but it often affects the C8 and T1 nerves of the lower trunk. Klumpke palsy causes paralysis of the forearm and hand muscles. Hence, grasp reflex can determine the affected part of the brachial plexus. Grasp reflex is done by stroking the palm of the baby’s hand and it is considered positive when the baby closes his or her finger in a grasp. Grasp reflex should last in babies until they reach 5 to 6 months old and disappear by 6 to 12 months of age.

            Another way of identifying of Erb’s palsy is by checking the baby’s Moro reflex. When Moro reflex is absent or loss on the affected side, Erb’s palsy is possible. Moro reflex is often called startle reflex. Moro reflex is done by placing baby with the face up on a soft padded surface and gently lift with enough support to just begin to remove the body weight from the pad. The head is then released suddenly, allowing to fall backward for a brief moment but with quick support again. Moro reflex is said to be present when the baby does have a startled look and the baby’s arm move sideways with the palms up and thumbs flexed. Moro reflex often peaks during the first month and disappears after about 2 months.

            According to the severity of the injury, Erb’s palsy can either resolve on its own over some time or may require treatment. Should treatment be needed, the baby may need rehabilitative therapy or surgery. Recommended treatment includes early immobilisation followed by a range of motion exercises. Daily physical therapy is the main treatment choice for Erb’s palsy. Others include hydrotherapy and medical therapy. Hydrotherapy allows the baby to move with less pain and at the same time strengthen the muscle and reduce spasms. It also helps to encourage normal movements in the affected arm. Medical therapy such as botulinum toxin injections sometimes are used to relieve muscle contracture.

            If there is no change over the first 3 to 6 months, doctors may suggest surgery to the nerve to improve outcome. Surgery often is microsurgery with nerve graft or nerve transfer. Since nerves recover very slowly, it may take months or even years before the repaired nerve reaches the muscle of the arm and hands. After surgery, doctors often provide rehabilitation exercises to be performed at home. Other surgical options are release of joint contractures and tendon transfers.

            In essence, brachial plexus injuries in most cases continue with weakness of the shoulder, arm or hand. Other surgical procedures may be performed at a later date to improve function. It is important for parents to always have discussions with doctors as their child grows to look for various treatment options and be offered with recommendations based on the child’s individual situation.

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