Paralysis of muscles
in the shoulder, elbow, and/or hand subsequent to
a nerve problem is called Brachial Plexus Palsy.
The Brachial Plexus
is a group of nerves that provide movement and feeling
to the arm. This group of nerves connects the spine
to the muscles to the arm and hand. When there is
a problem with these nerves, the signals going to
the appropriate muscles may be blocked or weakened,
preventing the muscles from moving normally. In
some cases, a problem with the Brachial Plexus also
involves partial paralysis of the diaphragm and/or
partial paralysis of the eye's pupil on the affected
sided. Paralysis of the eye's pupil is referred
to as Horner's Syndrome. Partial paralysis of the
diaphragm is called hemi-diaphragmatic palsy.
Dr. Wilhelm Heinrich Erb first
discovered a version of Brachial Plexus Paralysis.
Doctors have described paralysis of the arm in
infants dating back to the 1700's; but it was Dr. Wilhelm
Heinrich Erb, a German neurologist who located the most
common lesion in the 5th and 6th cervical roots which
supply the upper trunk of the Brachial Plexus. Injury
may occurs today in 1 out of 1,000 births.
It is undetermined
what all the causes of Brachial Plexus Palsy are. Researchers
have found, it often occurs in cases involving difficult
deliveries such as vaginal or cesarian section. Brachial
Plexus Palsies in infants can also result when key nerves
in the neck or arm have not fully developed. Other variables
like weight*, maternal diabetes,
first time or multiparous mothers and difficult births
may also play a part in infantile Brachial Plexus Palsy.
* (new-borns weighing more
than 4000 grams- 8.8 pounds)
There are many
degrees of severity in Brachial Plexus Palsy. The
upper brachial plexus palsy, or "Erb's Palsy",
is the most common type. It primarily affects the muscles
of the shoulder and elbow. The lower type, or "Klumpke's
Palsy" is uncommon and affects primarily the hand.
A true brachial plexus paralysis occurs when all five
nerves are affected.
outlook for the future is positive. Approximately 9 out of 10 infants
with brachial plexus palsy can recover on their own.
Their ultimate functional outcome will depend on the
degree of damage to the nerves and their parent's ability
to maintain the
joints supple and maintain their infant's interest in
the affected arm during the initial
first few months of life.
The prognosis for
the more common Erb's Palsy is considered to be more
favorable than in cases of Klumpke's Palsy or in cases
of total brachial plexus involvement. The presence
of hemi-diaphragmatic palsy or the presence of "Homer's
Syndrome" are considered less favorable signs. One out
often children who do not get better on their own will
continue to have significant weakness and difficulty
using the arm in every day activities. Deformities such
as a shorter, smaller arm, a permanently bent elbow
or internally rotated shoulder are commonly seen in
children that do not recover on their own.
Palsy is non discriminating. The chance
of a child having a brachial plexus palsy is equally
distributed according to gender, gestational age and
It occurs frequently in perfectly normal and healthy
infants. The reported incidence of
brachial plexus palsies statistically is approximately
1 in every 1000 live births.
is much controversy over the treatment and potential
recovery of infants with Erbs Palsy. The
main source of this controversy is
due to the confusing literature and statistics that are reported by various sources.
of full recovery can range from 30% to 95%. Undoubtedly
this reflects the specialty of the author. Primary
care physicians see many more infants who recover,
than the referral physician called on to surgically
treat the injury. Additionally, there is the question
as to what constitutes a good recovery.