why is the wrist flexed in erbs palsy

Erb's palsy is initially frightening. The infant's arm hangs limply from the shoulder with flexion of the wrist and fingers due to weakness of muscles innervated by cervical roots C5 and C6. Risk factors are macrosomia (large baby) and shoulder dystocia. However, Erb's palsy may occur following cesarian section.

Full Answer

What nerve is affected in Erb's palsy?

Erb's palsy is a paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the severing of the upper trunk C5–C6 nerves. These form part of the brachial plexus, comprising the ventral rami of spinal nerves C5–C8 and thoracic nerve T1.

What causes Erb's palsy in babies?

Erb's palsy is initially frightening. The infant's arm hangs limply from the shoulder with flexion of the wrist and fingers due to weakness of muscles innervated by cervical roots C5 and C6. Risk factors are macrosomia (large baby) and shoulder dystocia. However, Erb's palsy may occur following cesarian section.

What is the classical sign of ERB's palsy?

The classical sign of Erb's palsy is the ‘waiter's tip hand’. The arm hangs limply from the shoulder with internal rotation of the forearm plus wrist and finger flexion. Sometimes there are sensory deficits over the lateral proximal upper extremity (5).

How do cervical ribs cause Erb's palsy?

Cervical ribs may predispose to Erb's palsy by the stretching of nerves around the cervical rib or through concentrated pressure when the shoulder is forced against the cervical spine ( 8 ). However, most infants with cervical ribs do not have BPI.

What muscles are affected in Erb's palsy?

Erb's palsy or Duchenne-Erb paralysis involves the C5 and C6 roots of the brachial plexus. Palsy of C5 and C6 affects the strength of deltoid, biceps, brachialis, infraspinatus, supraspinatus, and serratus anterior muscles. Also involved are the rhomboids, levator scapulae, and supinator muscles.

Why is there claw hand in Klumpke palsy?

Klumpke's palsy, named after the neuroanatomist Augusta Déjerine-Klumpke who first described it, is when there is muscle paralysis in the hand, caused by nerve damage. This causes all the fingers to stay in a flexed position so it's also called “total claw hand.”

Is the radial nerve affected in Erb's palsy?

Affected nerves in Erb's palsy are the axillary nerve, musculocutaneous, & suprascapular nerve. posteriorly passing through the quadrangular space with posterior circumflex humeral artery. it fives rise to superior lateral brachial cutaneous nerve then winds around the surgical neck of the humerus deep to deltoid.

What happens in Erb's palsy?

Erb's palsy is a nerve condition in the shoulder and arm that results in weakness or loss of muscle function. The brachial plexus is a group of five nerves that connect the spine to the arm and hand. These nerves allow your shoulder, arms and hands to feel and move.

Why does ulnar claw occur?

An ulnar claw, also known as claw hand or 'spinster's claw', is a deformity or an abnormal attitude of the hand that develops due to ulnar nerve damage causing paralysis of the lumbricals.

What muscles cause claw hand?

Muscles innervated by the ulnar nerve include:Abductor digiti minimi.Flexor digitorum profundus.Flexor digiti minimi.Opponens digiti minimi.Ring finger lumbricals.Small finger lumbricals.Dorsal and palmar interosseous muscles.Adductor pollicis.More items...•

What causes dropped wrist?

Wrist drop is caused by damage to the radial nerve, which travels down the arm and controls the movement of the triceps muscle at the back of the upper arm, because of several conditions. This nerve controls the backward bend of wrists and helps with the movement and sensation of the wrist and fingers.

Why is it called Erb's point?

The nerve point of the neck, also known as Erb's point is a site at the upper trunk of the brachial plexus located 2–3 cm above the clavicle. It is named for Wilhelm Heinrich Erb. Taken together, there are six types of nerves that meet at this point.

What kind of muscle weakness does Erb's palsy cause?

Erb's palsy is a condition characterized by arm weakness and loss of motion. It can occur in both infants and adults. It's typically caused by a physical injury during newborn delivery or by traumatic force downward on the upper arm and shoulder, damaging the brachial plexus.

What is the difference between cerebral palsy and Erb's palsy?

Erb's palsy vs. Erb's palsy is caused by damage to neck nerves, whereas cerebral palsy is caused by damage to the brain. Erb's palsy also differs from other brachial plexus injuries such as Klumpke's palsy. This condition is uncommon in babies and causes paralysis of the lower brachial plexus, affecting hand muscles.

Is Erb's palsy the same as brachial plexus?

Brachial plexus palsy is weakness or paralysis in parts of the arm as a result of significant injury to the brachial plexus, which can happen during childbirth. The most common type of brachial plexus palsy is called Erb's palsy. Brachial plexus palsy may be caused during childbirth.

Which splint is used in Erb's palsy?

Does My Child Need an Erb's Palsy Splint? An Erb's palsy splint can be an effective part of treatment for Erb's palsy. They can be used to improve muscle tone and range of motion in the affected areas. There are many different kinds of Erb's palsy splints for different cases, and each type has its own use.

What causes hands to turn into claws?

The causes of Claw Hand might include: Nerve damage in the arm e.g ulnar palsy, median palsy, ulnar tunnel syndrome, cubital tunnel syndrome. Congenital birth defect. Some genetic diseases such as Charcot-Marie-Tooth Disease.

What causes hand of benediction?

Hand of benediction results from ulnar or median nerve neuropathy, leading to a claw-like configuration of the hand. The ulnar nerve innervates muscles of the 4th and 5th digits and when damaged, the digits are unable to bend and extend properly.

Which nerve is damaged in Klumpke's palsy?

Klumpke paralysis is caused by an injury to the nerves of the brachial plexus that which may result during birth due to a a difficult delivery. This injury can cause a stretch injury (neuropraxia), scarring, or tearing of the brachial plexus nerves.

What is complete claw hand?

Claw hand is a condition that causes curved or bent fingers. This makes the hand appear like the claw of an animal. Claw hand is a hand characterized by curved or bent fingers, making the hand appear claw-like.

Overview

Erb’s palsy is a nerve condition in the shoulder and arm that results in weakness or loss of muscle function. The brachial plexus is a group of five nerves that connect the spine to the arm and hand. These nerves allow your shoulder, arms and hands to feel and move.

Symptoms and Causes

Erb’s palsy affects the shoulder, arm and elbow. In general, your hand muscles aren’t affected, but your hands may experience tingling or numbness.

Diagnosis and Tests

The diagnosis usually begins with a physical examination. Your healthcare provider might also order these tests:

Prevention

There are certain risk factors related to shoulder dystocia (a baby’s shoulder being stuck inside the mother’s pelvis, which is related to Erb’s palsy). These factors include:

Living With

The longer a nerve injury remains untreated, the more difficult it may be to achieve an optimal outcome. Therefore, early on, you should see a specialist who can follow you or your infant to monitor your recovery and determine if intervention is necessary.

Frequently Asked Questions

The two conditions are similar in that they're both injuries that happen to the brachial plexus. However, the nerve damage in Erb’s palsy happens to the upper nerves and affects your arm. The nerve damage in Klumke’s palsy happens to the lower nerves. The lower brachial plexus nerves affect the muscles in the forearm and the hand.

What are the two types of brachial plexus injury?

In standard writings on brachial plexus injury, two basic types are recognized: the upper type, or Erb palsy, and the lower type, or Klumpke palsy (Figs. 36.15 and 36.16). In neonatal patients, approximately 90% of cases of brachial plexus injury involve the proximal upper limb and correspond to Erb palsy.a A true Klumpke palsy—that is, weakness of distal upper extremity only—in my experience does not occur in the newborn period; infants with distal involvement also exhibit proximal involvement. These neonatal patients with essentially total brachial plexus palsy often are described, appropriately or not, as Klumpke palsy.

What are the neurological features of ERB palsy?

The major neurological features of Erb palsy and total plexus palsy are best considered in terms of effects on muscle function, tendon reflexes (especially the biceps), Moro and grasp reflexes, and sensory function ( Tables 22-7 to 22-9 ). In general, the motor deficits are much more striking than the sensory deficits because ...

What causes epiphyseal underdevelopment in the humeral head?

A. Shoulder. Epiphyseal underdevelopment can occur in the humeral head as a result of neuromuscular dysfunction. Patients with Erb's palsy typically have a smaller humeral epiphysis and a poorly developed posterior glenoid. These conditions predispose one to posterior dislocation of the humeral head.

What muscles are affected by Duchenne-Erb paralysis?

Erb's palsy or Duchenne-Erb paralysis involves the C5 and C6 roots of the brachial plexus.9 Palsy of C5 and C6 affects the strength of deltoid, biceps, brachialis, infraspinatus, supraspinatus, and serratus anterior muscles. Also involved are the rhomboids, levator scapulae, and supinator muscles. Therefore, this injury causes severe restriction ...

What is shoulder dystocia?

Shoulder dystocia can result in Erb's palsy, clavicular fractures, fetal distress, low APGAR scores, as well as birth asphyxia when unrecognized. If mothers have poor glycemic control, respiratory distress syndrome may occur in up to 30% of infants because of decreased lung surfactant synthesis.

Why are motor deficits more striking than sensory deficits?

In general, the motor deficits are much more striking than the sensory deficits because of the overlapping innervation of sensory dermatomes, the greater involvement of anterior than posterior roots, and the difficulty of precise assessment of sensation in the newborn.

Why can't a patient supinate the forearm?

The patient is unable to abduct or externally rotate the shoulder. The patient cannot supinate the forearm because of weakness of the supinator muscle. Sensory involvement is usually confined along the deltoid muscle and the distribution of the musculocutaneous nerve.

Which injury is associated with a radicular lesion at the level of C5 and C6?

In 1874, Wilhelm Heinrich Erb concluded in his thesis on adult brachial plexus injuries that associated palsies of the deltoid, biceps and subscapularis are derived from a radicular lesion at the level of C5 and C6 rather than isolated peripheral nerve lesions.

What nerves are affected by Erb's palsy?

Erb's palsy primarily affects C5 and C6. Erb's palsy is a paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the severing of the upper trunk C5–C6 nerves. These form part of the brachial plexus, comprising the ventral rami of spinal nerves C5–C8 and thoracic nerve T1.

What are the most common nerves in the arm?

The most commonly involved nerves are the suprascapular nerve, musculocutaneous nerve, and the axillary nerve. The signs of Erb's palsy include loss of sensation in the arm and paralysis and atrophy of the deltoid, biceps, and brachialis muscles. "The position of the limb, under such conditions, is characteristic: the arm hangs by ...

What is the root of Erb-Duchenne palsy?

Erb–Duchenne palsy presents as a lower motor neuron syndrome associated with sensibility disturbance and vegetative phenomena.

Why is my arm not regulating temperature?

The lack of development to the circulatory system can leave the arm with almost no ability to regulate its temperature, which often proves problematic during winter months when it would need to be closely monitored to ensure that the temperature of the arm was not dropping too far below that of the rest of the body.

Who was the first person to describe a brachial plexus?

The renowned British obstetrician William Smellie is credited with the first medical description of an obstetric brachial plexus palsy. In his 1768 treatise on midwifery, he reported a case of transient bilateral arm paralysis in a newborn after difficult labour.

Can subscapularis be released at any age?

Subscapularis releases, however, are not time limited. Since it is merely cutting a "Z" shape into the subscapularis muscle to provide stretch within the arm, it can be carried out at almost any age and can be carried out repeatedly on the same arm; however, this will compromise the integrity of the muscle.

How long does it take for Erb's palsy to heal?

Erb's palsy resolves completely in the first year of life in 80% to 96% of patients and in nearly 100% if recovery begins within four weeks of birth ( 5 ).

How was a 4200 g baby delivered?

This 4200 g baby was delivered with low vacuum suction to a G1P0 mother. Labour was induced due to decreased fetal tone. Apgar scores were nine and nine. Moderate shoulder dystocia required suprapubic pressure, McRoberts maneuver and a ‘corkscrew’ maneuver. Severe right Erb's palsy was immediately noted with little wrist extension and no bicep or deltoid function. By six weeks of age, the baby still had no bicep or deltoid function; however, the brachioradialis and triceps were normal. With the Moro reflex, there was only supraspinatus contraction with a few degrees of abduction. This infant may still recover; however, plastic surgery assessment is planned if there is no improvement by five months.

What causes Erb's palsy?

Erb's palsy results from injury to nerve roots C5 and C6, with C7 also affected in 50% of instances. Muscles involved are listed in Table 1. The classical sign of Erb's palsy is the ‘waiter's tip hand’. The arm hangs limply from the shoulder with internal rotation of the forearm plus wrist and finger flexion. Sometimes there are sensory deficits over the lateral proximal upper extremity ( 5 ). C3 and C4 are injured in about 5% of patients leading to phrenic nerve dysfunction and paralysis of the hemidiaphragm ( 6 ). Horner's syndrome occurs rarely when the stellate ganglion is disrupted ( 5 ).

Why does my baby's arm hang from my shoulder?

The infant's arm hangs limply from the shoulder with flexion of the wrist and fingers due to weakness of muscles innervated by cervical roots C5 and C6. Risk factors are macrosomia (large baby) and shoulder dystocia. However, Erb's palsy may occur following cesarian section.

How does Erb's palsy affect children?

Although not carefully studied, a persistent Erb's palsy may affect the child' s quality of life and self esteem. Sporting activities are affected, as well as activities of daily living (for example, dressing with a tight sweater).

Is MRI of the brachial plexus and cervical cord the best imaging technique?

Beyond the physical examination, few investigations are indicated. MRI of the brachial plexus and cervical cord is likely the best imaging technique, if required. There is no convincing evidence of the reliability of electromyography to predict outcome. However, absent fibrillations likely indicate neuropraxia ( 5 ). If electromyography denervation persists, spontaneous recovery may be unlikely. Absent sensory conductions may be diagnostic of root avulsion ( 6, 19, 25 ).

Can a clavicular fracture cause pseudoparalysis?

Clavicular fracture may lead to a pseudoparalysis, easily mistaken for BPI. In one review of 11,636 deliveries ( 7 ), 2.3% had clavicular fracture and 0.4% had Erb's palsy. Eleven per cent of deliveries with clavicular fracture had Erb's palsy, while 53% with Erb's palsy had a clavicular fracture. Cervical ribs may predispose to Erb's palsy by the stretching of nerves around the cervical rib or through concentrated pressure when the shoulder is forced against the cervical spine ( 8 ). However, most infants with cervical ribs do not have BPI.

How long does it take to recover from a brachial plexus injury?

Thereafter examinations can be carried out less frequently. A minimal injury responds well to conservative treatment and spontaneous recovery occurs up to 18 months. A residual disability may be slight. Infraclavicular brachial plexus injuries carry a better prognosis than supraclavicular lesions.

What are the structures that are involved in shoulder surgery?

These involve releasing of tight structures namely the pectoralis major, subscapularis, anterior joint capsule, Latissimus Dorsi, and Teres major and muscle transfers to augment external rotation at the shoulder.

Which muscle is most commonly paralyzed by Erb's palsy?

Of these, Erb's palsy is the commonest. The muscles most frequently paralyzed are the Supra and Infraspinatus due to fixity and the resultant injury of the Suprascapular nerve. Other muscles innervated by the C5 and C6 roots may be affected. The clinical findings are variable.

What happens when the brachial plexus is injured?

When the entire brachial plexus is injured, and not just the nerves involved in Erb’s palsy, the whole arm will be affected, including the wrist and hands. Any symptoms of Erb’s palsy or brachial plexus injury should be taken seriously.

Why is it important to find other, more noticeable symptoms?

This is why it is important to find other, more noticeable symptoms so that the condition can be detected early and treated. Symptoms of Brachial Plexus Injuries in Adults and Children. Most cases of Erb’s palsy are in seen newborns and are generally due to difficulties associated with childbirth.

What is Erb's palsy?

For any content issues please Contact Us. Most common in newborns, Erb’s palsy is a condition caused by damage to some of the nerves that control the shoulder and arm. These nerves are a portion of a larger bundle of nerves, called the brachial plexus, which connects the spinal cord to the shoulders, arms, and hands, ...

What causes a burning sensation in the arm?

Car accidents, sports injuries, and even tumors can cause damage to the brachial plexus. Symptoms of this may include a burning sensation like an electric shock that passes down the arm, weakness or numbness in the arm, and paralysis, or pain. When the entire brachial plexus is injured, and not just the nerves involved in Erb’s palsy, ...

What is the term for a muscle weakness or paralysis?

American Academy of Orthopaedic Surgeons. The word palsy generally refers to muscular weakness or paralysis, where the source of the problem is an injury to some of the nerves. In the case of Erb’s palsy, the nerves affected are the ones that connect to the shoulder and upper arm.

How to test Moro reflex?

To test the Moro reflex, the baby is placed on its back. The arms are gently lifted and then let go together. This gives the feeling of falling, and the baby should appear startled during this maneuver, extending the arms outward first, then to the front, and finally back again to the sides.

How to tell if an infant has Erb's palsy?

Another sign of Erb’s palsy, often seen in newborns, is an awkward positioning of the affected arm. The infant may hold its arm extended downward and rotated in toward its side, which does not look normal.

Definition/Description

• Erb's palsy or Erb–Duchenne palsy is a form of obstetric brachial plexus palsy. It occurs when there's an injury to the brachial plexus, specifically the upper brachial plexus at birth. The injury can either stretch, rupture or avulse the roots of the plexus from the spinal cord. It is the most c…

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Mechanism of Injury / Pathological Process

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Outcome Measures

Management / Interventions