| Erb's palsy Classification and external resources |
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| Brachial plexus | |
| ICD-10 | P14.0 |
| ICD-9 | 767.6 |
| DiseasesDB | 30827 |
Erb's Palsy (Erb-Duchenne Palsy, Brachial plexus paralysis) is a paralysis of the arm caused by injury to the upper group of the arm's main nerves (specifically, spinal roots C5-C7), almost always occuring during birth. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings P00-P96 - Certain conditions originating in the Perinatal period (P00-P04 Fetus and newborn affected by maternal factors and by complications of pregnancy labour and The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. The brachial Plexus is an arrangement of nerve fibers running from the spine formed by the Ventral rami of the lower cervical and upper thoracic nerve roots specifically Depending on the nature of the damage, the paralysis can either resolve on its own over a period of months, necessitate physical therapy or require surgery. [1]
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Cause
The most common cause of Erb's palsy is dystocia, an abnormal or difficult childbirth or labour. Dystocia ( Antonym eutocia) is 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. The vagina (from Latin, literally " Sheath " or " Scabbard " is a fibromuscular tubular tract leading from the Uterus [2]
The condition can also 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). A breech birth (also known as breech presentation) refers to the position of the Baby in the Uterus such that it will be delivered [2]
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. Dystocia ( Antonym eutocia) is an abnormal or difficult Childbirth or labour [3]
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 furthest 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. The suprascapular nerve arises from the trunk formed by the union of the fifth and sixth Cervical nerves. The musculocutaneous nerve arises from the Lateral cord of the Brachial plexus, opposite the lower border of the Pectoralis minor, its fibers being derived The axillary nerve is a Nerve of the human body that comes off the Posterior cord of the Brachial plexus at the level of the Axilla (armpit [4]
The injury often leaves patients with stunted growth in the affected arm with everything from the shoulder though to the fingertips smaller than the unaffected arm. This also leaves the patients 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 sterlised 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 Pasly, but it is also the most varying. There have been cases of patients who have lost complete sensory perceptinon 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.
Treatment
Some babies recover on their own; however, some may require specialist intervention.
Neonatal / pediatric neurosurgery is often required for avulsion fracture repair. An avulsion fracture is a Bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of Physical trauma. 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. Arthritis (from Greek arthro-, joint + -itis, inflammation plural arthritides is a group of conditions involving damage to the Joints of the body
The three most common treatments from Erb's Palsy are: Nerve transfers (usually from the opposite leg), Sub Scapularis releases and Latissimus Dorsi Tendon Transfers.
The nerve transplants are usually performed on babies under the age of 9 months since the fast development of younger babies increases the effectiveness of the prodedure. They are not usually carried out on patients older than this because, although small babies nerves can recover to an extent, when the procedure is done on older infants, more harm than good is done and can result in nerve damage in the area where the nerves were taken from. Scarring can very from faint scars along the lines of the neck to full "T" shapes across the whole shoulder depending on the training of the surgeon and the nature of the transplant.
Subscapularis releases, however, are not time limited. Since it is merely cutting a "Z" shape into the subscapularis muscle to provide stretch within the arm, it can be carried out at almost any age and can be carried out repeatedly on the same arm, hoe ever this will comprimise the integrety on the muscle.
The Latissimus Dorsi Tendon Transfers involve cutting the Latissimus Dorsi in half horizontally in order to 'pull' part of the muscle around and attach it to the outside of the bicap. This procedure provides external rotation to varying degrees of success. A side effect of this may be incresed sensitiviy on the part of the bicep where the muscle will now lie since the Latissimus Dorsi has roughly twice the amount of nerve endings per square inch than other muscles.
Discovery
The renowned British obstetrician William Smellie is credited with the first medical description of an obstetric brachial plexus palsy. William Smellie, born 1697 in Lanark, Scotland, died March 5, 1763 in Lanark was a preeminent Obstetrician and has been called The brachial Plexus is an arrangement of nerve fibers running from the spine formed by the Ventral rami of the lower cervical and upper thoracic nerve roots specifically 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. Guillaume Benjamin Amand Duchenne (born September 17, 1806 in Boulogne; died September 15, 1875) was a French Neurologist [5][6] 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. Wilhelm Heinrich Erb ( November 30, 1840 - 1921 was a German Neurologist who was a native of Winnweiler, Palatinate. The Subscapularis is a large triangular muscle which fills the Subscapular fossa. [7]
Notable people with Erb's palsy
Notable individuals afflicted by Erb's palsy were Wilhelm II of Germany,[8] Joseph Stalin, Queen Victoria of Britain, and Canadian journalist Barbara Frum. Joseph Stalin ( ნამდვილი გვარი ჯუღაშვილი|Iosif Vissarionovich Dzhugashvili; March 5 1953 was General Secretary of the Communist Party Victoria (Alexandrina Victoria 24 May 1819 – 22 January 1901 was from 20 June 1837 the Queen of the United Kingdom of Great Britain and Ireland Barbara Frum, OC, BA, LLD ( September 8, 1937 &ndash March 26, 1992) was a Journalist, acclaimed Martin Sheen was injured during birth and developed the condition in his left arm. Martin Sheen (born Ramón Gerardo Antonio Estévez on August 3, 1940) is a Golden Globe and Emmy Award winning American Actor who earned His difference in arm length and range of motion can be seen in his movies, especially Apocalypse Now. Another sufferer is British singer-songwriter and artist, Matt Parsons.
See also
References
- ^ [1]
- ^ a b A.D.A.M Healthcare center
- ^ Peleg D, Hasnin J, Shalev E (1997). Klumpke's paralysis or Klumpke's palsy or Dejerine-Klumpke palsy is Palsy of the Brachial plexus. "Fractured clavicle and Erb's palsy unrelated to birth trauma". American Journal of Obstet. Gynecol. 177 (5): 1038-40. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 9396889.
- ^ Norman/Georgetown clinicalconsiderations
- ^ synd/946 at Who Named It
- ^ G. Georgetown University is a Jesuit Private university located in Georgetown Washington D Who Named It? is an English-language dictionary of medical eponyms and the People associated with their identification 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). The National Institute of Neurological Disorders and Stroke is a part of the U Duke University is a private Research University located in Durham, North Carolina, United States. "Wilhelm Heinrich Erb, M. D. (1840 to 1921): a historical perspective on Erb's palsy". Plast. Reconstr. Surg. 119 (7): 2161-6. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17519716.