ERBS PALSY

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Paediatric - Neurosurgery

Also known as Brachial Palsy, Brachial plexus injury

ABOUT THE DISEASE

The brachial plexus is a network of nerves that conducts signals from the spine to the shoulder, arm, and hand. Brachial plexus injuries are caused by damage to those nerves. A BPI (brachial plexus injury) occurs when these nerves are stretched or, in the most serious cases, torn. This happens as result of shoulder being pressed down forcefully while the head is pushed up and away from that shoulder. There are different kinds of BPI depending upon the severity of the injury, ranging from Avulsion i.e when the nerve has been pulled out from the spinal cord and has no chance to recover to Rupture and Neurapraxia i.e when the nerve has been gently stretched or compressed but is still attached (not torn) and has excellent prognosis for rapid recovery.

CAUSES

- Babies sometimes sustain brachial plexus injuries during birth.
- The infant`s head and neck pulling toward the side as the shoulders pass through the birth canal.
- Pulling on the infant`s shoulders during a head-first delivery.
- Pressure on the baby`s raised arms during a breech (feet-first) delivery.

Other conditions, such as injury due to fall/accident, inflammation or tumors, may also affect the brachial plexus.

A brachial plexus injury occurring during birth is called birth related brachial plexus palsy or obstetric brachial plexus palsy.

Erb`s Palsy refers to an injury of the upper brachial plexus nerves leading to loss of motion around the shoulder and ability to flex the elbow.

SYMPTOMS

BPI may result in some of the following symptoms:

• Pain
• Loss of sensation
• Muscle weakness / lack of muscle control in hand, wrist or arm
• Limp or paralysed arm

In the case of new borns, it is manifested in terms of absent moro reflex on the affected side or characteristic position - adduction and internal rotation of the arm with forearm pronated.

DIAGNOSIS

- Physical examination
- Electrodiagnostic studies - EMG, SNAP, SEEP, NCV
- Imaging studies - CT Scan, MRI

TREATMENT METHODS

Minor injuries may get better on their own, but severe brachial plexus injuries require surgical repair. It may include Nerve graft, Nerve transfer or Muscle transfer. Many children who are injured during birth improve or recover by 3 to 4 months of age.