Causes and Risk Factors of Erb’s palsy | Neurology

Erb's palsy

What Is Erb’s Palsy?

Erb’s palsy affects the part of the “brachial plexus”. The brachial plexus originates from the spinal cord. It is located in the arm and between the neck bones. Nerves in your body form a complex pathway for communication. Erb’s palsy disrupts this flow.

There are nerves in the upper part of the neck that provide flexibility and support for the arm. The condition occurs when the main nerve stem is cut off.

Different nerves in the lower part of the neck control feeling and flexibility in the hands and fingers. This is why you may see babies who cannot move the upper arm but can wiggle their fingers. When paralysis affects the entire arm, hand, and fingers, and it is called plexiglass plexus.

Generally, there are four types of nerve injuries. They can all occur at the same time in the same infant. Indications of a nerve injury are the equivalent (loss of feeling and halfway or complete loss of motion), paying little mind to the sort of injury. It is the severity of the injury that influences treatment decisions and the extent of possible recovery.

Types of Erb’s palsy injuries

  1. Neurapraxia: The most common type is a stretching injury that “strikes” but does not tear the nerve. This is called “Neurapraxia”. Typically, these injuries heal on their own, usually within 3 months. Neurapraxia can occur in adults as well as infants. For example, when it occurs to soccer players who are injured while playing, it is called “stinging”.
  2. Neuroma: A stretching injury that damages some nerve fibers may result in a scar. Scar tissue may compress a remaining healthy nerve. This condition is called “neuroma”. There is usually some healing, but not completely.
  3. Rupture: A stretching injury that causes a nerve to tear (rupture) will not heal on its own. A tear occurs when the nerve itself is torn.
  4. Avulsion: Extraction occurs when a nerve is torn from the spinal cord. Nerve tears and extractions are the most serious types of nerve injuries. It may be possible to repair the tear by ‘braiding’ a nerve graft from another nerve to the child. Ejaculation cannot be repaired from the spinal cord. Now and again, it might be conceivable to reestablish some capacity in the arm by utilizing a nerve from another muscle as a contributor.

Symptoms of Erb’s palsy

The injury that causes Erb’s palsy occurs during childbirth. Signs of damage or injury include decreased reflexes on the affected side, no movement in the arm or part of the arm, less grip strength in the affected hand, bending of the arm at the elbow, and a firm grip on the infant’s side.

If the condition is not somehow detected until later, the child may experience weakness, loss of sensation, or partial or complete paralysis in the arm.

Causes and risk factors of Erb’s palsy

The most common cause of Erb’s palsy is excessive straining or pulling of a baby’s head and shoulders during vaginal delivery. For example, if an infant’s head and neck are pulled to the side at the same time as the shoulders pass through the birth canal, this may cause Erb’s palsy.

This birth injury can also result from excessive straining of the shoulders during the birth of the head first, or by stressing the infant’s raised arms during the birth of the foot first. This usually occurs when the baby is “stuck” in the birth canal, requiring the caregiver to pull more forcefully to remove the baby.

Erb’s palsy can also develop depending on the baby’s position in the birth canal. This condition is common in children who are larger and have broad shoulders. What usually happens is that the infant’s head falls into the birth canal but one shoulder is retracted due to the mother’s pubic bone. When the baby’s head is pushed down into the birth canal, the nerves stretch, causing Erb’s palsy.

A baby’s risk of developing Erb’s palsy roughly triples if he develops shoulder dystocia during birth. This occurs when the infant’s head is delivered, but both shoulders are stuck inside the mother’s uterus.

Include risk factors for developing Erb’s palsy:

  • Big baby size
  • Maternal diabetes
  • The shape of the mother’s pelvis is small or abnormal
  • Use of extraction tools during childbirth
  • The second stage of labor lasts more than an hour
  • Excessive maternal weight gain

Erb’s palsy treatment options

In most cases, children who develop Erb’s palsy should be referred to a treatment center that offers multidisciplinary specialties. These types of treatment centers consist of a large team of doctors specializing in different areas of healthcare, such as neurologists, neurosurgeons, physical therapists, occupational therapists, and orthopedic surgeons.

However, not all children have the option to go to a multidisciplinary treatment center. In these cases, your child should be examined by a pediatric neurologist.

Include treatment options:

Surgery

If the doctor recommends surgery, it should be performed within the first three to six months after birth, unless your child’s doctor recommends otherwise. Studies show that delaying surgery until a child is older reduces the chances of a successful operation. Microsurgical techniques should be performed around three months old. Surgical attempts to restore partial arm function to treat cardiac injuries should be made around six months of age.

Non-surgical treatment options

When nerve injuries to the brachial plexus are mild, the best approach is usually physical therapy, which should include a gentle massage around the affected arm. Physical therapy also includes the use of techniques such as range of motion exercises to improve arm strength and flexibility, as well as nerve function. In some cases, injecting Botox into the affected area, and applying electrical stimulation may help your child recover. If nerve function does not return after six to eight weeks of treatment and other forms of treatment, your doctor may recommend surgery.

However, it is important to note that home care is just as important. For example, you will need to gently massage the baby’s arm and do physical therapy exercises at home, along with physical therapy sessions. Make sure to participate during your child’s physical therapy sessions so that you understand which type of exercises you should do at home.

Complications

Most children and older patients with Erb’s palsy regain strength and movement in the affected arm. In rare cases, the affected arm may grow slightly shorter, fail to regain full strength, or be unable to make circular movements.

Diagnosis of Erb’s palsy

To determine whether an infant or an older patient has Erb’s palsy, a doctor will perform a physical exam to assess arm weakness. Then we use advanced diagnostic procedures and techniques to effectively diagnose, inform treatment, and carefully monitor the condition. It may include diagnostic procedures:

  • Electromyogram (EMG): This test measures the electrical activity of the muscle in response to stimulation, as well as the nature and speed of conduction of electrical impulses along a nerve. To confirm the presence of nerve damage and assess its severity.
  • Imaging studies: The doctor may order an X-ray, ultrasound, or another imaging test to check for damage to the bones and joints of the neck and shoulder.
  • Nerve conduction studies: These tests measure the ability of individual nerves to send an electrical signal from the spinal cord to the muscles.

The doctor places an electrode to directly shock the nerve to be studied, and an electrode to record over the muscles provided by that nerve. The shock electrode sends brief and repeated electrical impulses to the nerve, and the recording electrode records the time it takes the muscle to contract in response to the electrical impulse.

Outcomes

Many children with brachial plexus injuries will continue to feel some weakness in the shoulder, arm, or hand. There may be other surgical procedures that can be performed at a later time that may improve function. As your child grows, your doctor will discuss various treatment options and make a specific recommendation based on your child’s individual condition.

Prevention

Most cases of Erb’s palsy are preventable in infants:

  • Advanced planning: If the baby is older than usual or in an incorrect position in the weeks leading up to the due date, advance planning by the obstetrician to prevent Erb’s palsy should include ensuring that qualified personnel is present in the delivery room, proper use of birth aids and extractions and induction of labor or cesarean delivery if Several risk factors have been identified.
  • Maternal healthcare: Good maternal health care during pregnancy, including avoiding or controlling diabetes, can help to prevent Erb’s palsy.

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