Erb's palsy or Erb-Duchenne palsy is arm paralysis caused by an injury to the upper arm's main nerve group, particularly termination of the upper stem of the C5-C6 nerve. It is part of the brachial plexus, consisting of the spinal flask of the C5-C8 spinal cord and the T1 thoracic nerves. This injury is most common, but not exclusively, from shoulder dystocia during difficult labor. Depending on the nature of the damage, paralysis may heal itself within months, requiring rehabilitation therapy, or require surgery.
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Paralysis can be partial or complete; damage to each nerve can range from bruising to tearing. The most common root involved is C5 (aka Erb's point: C5 & C6 root unification) because this is the farthest point of traction force, therefore, the first/least affected. Erb-Duchenne palsy is present as a lower motor neurone syndrome associated with a sensibility disorder and vegetative phenomenon.
The most common nerves involved are the suprascular nerve, the musculocutaneous nerve, and the axillary nerve.
Signs of Erb's Palsy include loss of sensation in the arm and paralysis and atrophy of deltoid, biceps, and brachial muscles. "The position of the extremity, under such circumstances, is characteristic: the arm hangs on the side and is rotated medially, the forearm is extended and the pronation of the arm can not be lifted from the side; all elbow flexion strength is lost, as is the supine forearm." The resulting damage to the biceps is the main cause of this classical physical position commonly called "waiter tip".
If an injury occurs at an early age to affect progression (eg as neonate or infant), it often leaves the patient with stunted growth in the affected arm with everything from the shoulder to the fingertips smaller than the unaffected arm. It also makes patients with disorders of muscle development, nerves and blood circulation. Lack of muscle development leads to a much weaker arm than unaffected, and less articulate, with many patients unable to lift arms above shoulder height unaided, leaving many with elbow contracture.
The lack of development of the circulatory system can leave the arm with almost no ability to regulate its temperature, which often proves problematic during the winter when it needs to be monitored to ensure that the arm temperature does not drop too far down. that of the rest of the body. But damage to the circulatory system also leaves the arm with other problems. This reduces skin healing ability, so skin damage takes longer than normal to heal, and infections in the arm can be quite common if the wound is not sterilized as soon as possible. This will often cause many problems for children because they often hurt themselves in their childhood.
Nerve damage is often a problem with side effects for Erb's Palsy, but also the most varied. There are several cases of patients who missed complete sensory perception in the arm after the procedure in which they had a full prior sensory perception. The most common area for loss of sensory perception (except where the arm faces total loss) is that between the shoulders and the elbow because the nerves that provide information from that area to the brain are also the first damaged in the initial cause trauma.
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Cause
The most common causes of Erb's palsy are dyspnoea, abnormal or difficult labor or delivery. For example, it can occur if the baby's head and neck are pulled sideways at the same time as the shoulder passes through the birth canal. This condition can also be caused by excessive withdrawal on the shoulder during a head presentation (first head delivery), or with pressure on the raised arm during the breech (first leg) of delivery. Erb's palsy may also affect neonates exposed to clavicle fractures that are unrelated to dystocia.
Similar injuries can be observed at any age after head and shoulder trauma, which causes the plexus nerve to enlarge violently, with the upper trunk of the plexus having the greatest injury. Injuries can also occur as a result of direct violence, including gunshot wounds and traction on the arm, or attempting to reduce dislocation of the shoulder joint. The degree of damage to the constituent nerves is related to the amount of paralysis.
Diagnosis
The appearance of the affected arm (or arm) depends on the individual case. In some cases the arm may not have the ability to straighten or twist but otherwise function normally providing the overall look of the arms becomes stiff and bent. While in other circumstances his arm has no control and has a "loose" appearance. Treatments such as physiotherapy, massage and electrical stimulation can help prevent this from early on (or throughout) the life of the patient by strengthening the arm.
In some cases, again, the individual may suffer a lot of discomfort. For example, they may experience severe cramping pain that lasts for some time and is very painful after they fall asleep, running from the shoulders down to the wrist. Although the pain does not affect everyone with Erb's Palsy, it can be very uncomfortable for those who do it and may even cause the patient to be physically ill or faint. This extreme nerve pain occurs mostly during the late stages of growth and is almost always reduced in time. Other pains that can be experienced by people with Palsy Erb include muscle tension, stiffness, circulatory problems and cramps. The different factors depend on the severity of the condition and may vary, so while some patients experience a lot of pain, some patients may not experience pain at all and for their affected arm it only becomes visually bent.
Discomfort with shoulder blades is also very common in Erb because the shoulders are often at risk of dislocation. This may result, once again, in a state of illness or lack of sleep.
Treatment
Some babies heal themselves; however, some may require special interventions.
Neonatal/pediatric neurosurgery is often required for repair of avulsion fractures. The lesion can heal over time and return to work. Physiotherapy treatments are often needed to regain muscle use. Although the range of motion recovers in many children under one year of age, individuals who have not recovered after this point will rarely get full function in their arms and may develop arthritis.
The three most common treatments for Erb's Palsy are: Nerve transfer (usually from opposing arm or limb), Sub Scapularis release and Latissimus Dorsi Tendon Transfer.
Nerve transfer is usually performed in infants under 9 months of age since the rapid development of younger infants improves the effectiveness of the procedure. They are usually not performed on patients older than this because when the procedure is performed on older babies, it is more dangerous than well done and can result in nerve damage in the area where the nerve is removed. Scars may vary from a faint scar along the neckline to a full "T" shape across the shoulder depending on surgeon training and transplantation traits.
But the release of subscapularis is not time constrained. Because it simply cuts the "Z" shape into the subscapular muscles to give it a stretch in the arm, it can be done in almost any age and can be done repeatedly on the same arm; However, this will compromise the muscle integrity.
Latissimus Dorsi Tendon Transfer involves cutting Latissimus Dorsi half horizontally to 'pull' part of the surrounding muscle and attach it to the outside of the biceps. This procedure provides external rotation with varying degrees of success. Side effects can increase the sensitivity of the biceps where the muscles will now lie down, because Latissimus Dorsi has about twice the amount of nerve endings per square inch of other muscles. This condition should not be taken lightly, untreated as an adult becomes unmanageable due to bone deformation, arthritis and if presant nerve pain. Also in the majority of excessive use of the arm is not done to be painful with age and also needs to be monitored by a doctor.
History
The famous English professor, William Smellie, is credited with the first medical description of the plexus of the obstetric brachial plexus. In his 1768 treatise on midwifery, he reported cases of temporary bilateral arm paralysis in newborns after difficult labor.
In 1861, Guillaume Benjamin Amand Duchenne coined the term "obstetric palsy of the brachial plexus" after analyzing four infants with identical muscle paralysis in the arms and shoulders, after publishing his initial findings in 1855. In 1874, Wilhelm Heinrich Erb concluded in his book. thesis on an adult brachial plexus injury associated with deltoid palsies, biceps and subscapularis derived from radicular lesions at C5 and C6 levels rather than isolated peripheral nerve lesions.
Popular people with erb's palsy
Prominent figures with Erb's hammer are Kaiser Wilhelm II of Germany, and Canadian journalist Barbara Frum. Martin Sheen was injured at birth and developed a condition in his left arm. Differences in arm length and range of motion can be seen in the film, especially Apocalypse Now .
The professional wrestler Traci Brooks has Erb's palsy and has achieved a successful career. Another is the former defensive Iowa Hawkeyes midfielder Adrian Clayborn. In addition, gangster rapper and Academy Award winner DJ Paul from Three Six Mafia also has a condition on his arm, which he often hides by wearing a cast during public appearances. And teenage archery champion Faith Oakley, who has Erb's weakness that affects her right arm, uses her teeth to pull the bowstring to fire an arrow.
Military spacing also caused Erb's paralysis in Military School cadets.
See also
- Klumpke's paralysis
References
Further reading
- Brachial-Plexus-Injury in NINDS
- Watt AJ, Niederbichler AD, Yang LJ, Chung KC (2007). "Wilhelm Heinrich Erb, M.D. (1840-1921): a historical perspective on Erb's error". Plast. Reconstruction. Roll up . 119 (7): 2161-6. doi: 10.1097/01.prs.0000260726.74745.b8. PMID 17519716.
External links
Source of the article : Wikipedia
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