Erb-Duchenne palsy is normally caused at birth and is an injury associated with the upper portion of the arm affecting the main group of nerves. The extent of the damage has a great deal to do with the type of treatment necessary for correcting it. Living with Erbs Palsy may result in temporary paralysis that can last only a few months, or require long term therapy and even surgery.
This type of palsy is often caused during childbirth when shoulder dystocia occurs. Shoulder dystocia is the condition whereby the baby's head presents but the shoulders are unable to pass through the pelvic bone without some form of manipulation. This is almost always an emergency situation because the umbilical cord is being compressed; time is limited to five minutes due to the possibility of a fatality.
The condition can also present in adulthood due to a serious fall. If a person falls to one side on the shoulder, head and neck stretching the nerves severely this condition results. Other possible causes are repairing a dislocated shoulder and damage due to a gunshot wound.
There are three nerves most affected which include the axillary nerve, the suprascapular nerve and the musculocutaneous nerve. Damage with respect to each nerve can be either tearing or bruising. Partial or complete paralysis is possible as a result.
The Erbs Point is named after Wilhelm Heinrich Erb who was a German neurologist. This is the area that suffers damage and at this point six nerves are joined. Its location is just above the collar bone. All of the nerve fibers along the spine that continue through the neck, armpit and continue through the arm are included.
The signs associated with the condition can be anywhere from loss of sensation to complete paralysis due to weakening of specific muscles involved; deltoid, biceps and brachialis. The arm generally cannot be raised and remains in a position of hanging by the side rotated toward the front with the hand facing forward. This positioning is commonly referred to as waiters tip.
The three common forms of treatment involve nerve transfer; with nerves being taken from the opposing leg, subscapularis release and latissimus dorsi tendon transfer. Nerve transplants are usually reserved for babies under the age of nine months, due to the possibility of additional nerve damage. There are normally no time limitations for the other procedures.
Subscapularis release can be done on more than one occasion if necessary to increase the range of motion within the arm, but the muscle may be compromised. Increased sensitivity is possible with the latissimus dorsi tendon transfer due to the position in which the muscle will lie after surgery, but improved external rotation is given to the arm.
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