Living With Erbs Palsy Including Explanations Concerning The Condition And Treatment
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.
Partial or complete paralysis are very real possibilities. Three particular nerves are the most affected and these include the musculocutaneous nerve, the axillary nerve and the suprascapular nerve. Bruising or tearing of these nerves can cause the damage.
The area affected is known as the Erbs Point which is named for Wilhelm Heinrich Erb a German neurologist. There are six nerves that join together at this point. Its location is just above the collar bone and includes all of the nerve fibers that run from the spine through the neck, then through the armpit and arm.
Signs associated with the palsy can range from lack of sensation to paralysis of the arm because of weakened muscles that are involved. The muscles that become most affected by this condition are the brachialis, the deltoid, and the biceps. Generally the arm is unable to be raised and must be left in a position of hanging at the side with the hand facing toward the front. Waiters tip is a common name for this position.
There are three common types of treatment including nerve transfers; nerves are taken from an opposite leg, latissimus dorsi tendon transfers and subscapularis releases. Due to possible nerve damage, nerve transplants are generally only done on infants that are less than nine months of age. At present age limitations are not a concern for other procedures.
External rotation is improved by tendon transfer however, due to muscle position following surgery; increased sensitivity is a very common occurrence. Range of motion can be greatly increased with subscapularis releases and this procedure can be done more than once if necessary. There is the possibility of weakening the existing muscle with the surgery being repeated.
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