Orthopaedic Surgery/Brachial Plexus Palsy

Brachial Plexus Palsy, also referred to as Erb's Palsy, is type of obstetric brachial plexus injury, which is complication during delivery. Symptoms include paralysis of the arm or shoulder, lack of muscle control in the arm, a decrease of sensation in the arm or hand.

The Brachial Plexus is located on the right and left side of your neck, between the neck and shoulder area. It is a group of nerves that run from the spinal cord through the arm to the wrist and hand.

Q. What is a Brachial Plexus Injury?

A. A brachial plexus injury is an injury to the nerves that supply the muscles of the arm. Injury to nerves of the brachial plexus can result in complete to partial paralysis to the shoulder, upper arm, elbow, forearm, wrist, hand, or fingers.

Q. Are there various degrees of severity with a Brachial Plexus Injury?

A. There are four basic types of nerve injuries. Some people only have one type while others have a combination of two or more types. � Avulsion- the nerve is detached from the spinal cord. � Rupture- the nerve is separated from itself, but not at the juncture of the nerve and the spinal cord. There may be one or more ruptures in a single nerve. � Praxis or Traction- the nerve is typically overstretched and damaged, but not detached from itself or the spinal cord. � Neuroma- scar tissue has surrounded the injured nerve and excessive pressure is now placed on the nerve. Therefore, the nerve has trouble getting all the signals to the muscle to be able to perform a movement.

Q. How do Brachial Plexus Injuries occur?

A. Brachial plexus injuries occur when there is excessive stretching, tearing, or other trauma to the brachial plexus network. Injuries can be sustained during delivery of a baby. This is known as Obstetrical Brachial Plexus. Traumatic Brachial Plexus is seen when injuries are sustained secondary to vehicular accidents such as automobiles, motorcycles, or boats, sports injuries particularly football, gunshot wounds, or surgeries. Traumatic BPI's have also been noted with animal bites or puncture wounds.

Q. What are some symptoms associated with Brachial Plexus Injuries?

A. There are several degrees of symptoms that can be seen with BPI. Here are some of the most typical examples: � Limited active range of motion of the entire arm or any part of the arm. � Sensation changes in the involved arm. � Weakness of specific muscle groups. � Poor ability to perform typical midline activities. � Poor ability to weight bear through the arm. � Neglect of the affected arm. � Posturing of the arm in atypical positions. � Developmental Delay � Torticollis- a shortened muscle of the neck, so the head tilts to one side.

Q. How often do obstetrical brachial plexus injuries occur?

A. The current research suggests that brachial plexus injuries are seen 1-4 in every 1000 live births.

Q. What are the treatments?

A. Treatments include but are not limited to the following: Physical therapy, occupational therapy, aquatic therapy, surgical interventions, splinting, casting, electrical stimulation.

Q. When should I initiate treatments?

A. It is essential that a person suffering from a brachial plexus injury initiate treatments as soon as possible. Typically, a person suffering from an obstetrical brachial plexus injury sees a physical therapist or occupational therapist in the first two weeks of life. The goal of the therapist is to assist the family in Range of motion exercises, assess for muscle contractions even when movement is not seen, address positioning, make adaptive equipment, reduce the infant's tendencies toward neglect, and avoid atypical movement patterns, avoid tightening of muscles, and assist with weight bearing activities even in the newborn stage.

References and Resources: Erb's Palsy Center for Awareness