Erb Palsy Brachial Palsy In The Newborn

Overview, Causes, & Risk Factors

Brachial palsy is a condition where an infant’s arm ispartly or completely paralyzed at birth.

What is going on in the body?

Brachial palsy is a birth injury that can happen to newbornsduring delivery of the head and shoulders. The brachial plexus is anetwork of nerves that join together to form the nerves of the arm, hand,and fingers. If the brachial plexus is stretched during delivery, the newbornmay have weakness or paralysis involving all or part of an arm.

What are the causes and risks of the condition?

The injury is more likely to happen if the baby is large and thebony outlet of the mother’s pelvis is small, relative to the baby. The brachialplexus can be stretched if the person assisting in the delivery has to pull onthe baby’s head and neck in order to deliver the shoulders. It can also happenwith breech delivery, if the baby’s arms are extended above his or her headduring the delivery.

Symptoms & Signs

What are the signs and symptoms of the condition?

A newborn with brachial palsy holds the affected arm close tothe body. The elbow is not bent, and the hand is turned palm down. Theinfant cannot move the affected arm. Sometimes only the upper part ofthe arm is affected, and the baby can move the hand and fingers. Oftenthe entire arm, including the hand and fingers, is affected.

Diagnosis & Tests

How is the condition diagnosed?

The healthcare provider can generally diagnose brachial palsyby observing the infant’s arm position and movement. The provider may orderan X-ray, CT scan,or MRIscan if a collarbone fractureis suspected.

Prevention & Expectations

What can be done to prevent the condition?

It is not easy to predict whether there is going to be difficultydelivering the baby’s shoulders. If the mother is known to have a smallpelvic outlet and to be carrying a large baby, the infant may be delivered bycesarean section.

What are the long-term effects of the condition?

The long-term effects of brachial palsy will vary, depending onthe degree of damage to the brachial plexus. If mild damage occurs,the symptoms may improve within several days to 6 months. With severe damage,permanent paralysis may occur.

What are the risks to others?

Brachial palsy poses no risk to others.

Treatment & Monitoring

What are the treatments for the condition?

If the injury to the nerves is mild, arm and hand function usuallyreturn after several months. If the nerves are actually torn, normal functionmay never be recovered. Fortunately, injuries of this severity are rare. If itappears that nerve function is not returning quickly, the arm and hand canbe placed in splints while the infant is sleeping to maintain the normal jointfunction. Range-of-motion exercisesmay be recommended to keep muscles strong and active.

What are the side effects of the treatments?

Splints can cause skin irritation or rash.

What happens after treatment for the condition?

A child who has full recovery from brachial palsy will need nofurther treatment. A child who has mild to moderate nerve damage may needphysical therapyto improve use of the arm and hand. A child who has full paralysis mayneed periodic physical therapy to adjust to using different equipment.

How is the condition monitored?

Brachial palsy can best be monitored by the caregiver and, asthe child gets older, by the child. Any new or worsening symptoms shouldbe reported to the doctor.

Article type: xmedgeneral