P13.0 Erb paralysis due to birth injury
P14.1 Klumpke paralysis due to birth injury
P14.3 Other brachial plexus birth injuries
PREFERRED PRACTICE PATTERN3
A 3-week-old infant is referred to outpatient physical therapy for right Erb palsy. The mother reports an uneventful pregnancy but prolonged and difficult delivery especially in getting the shoulder out of the birth canal. Upon examination, the infant presents with fisting of the left hand and physiologic flexion of the elbow typical of a newborn but the right arm is postured by the baby’s side. There is full passive range of motion (ROM) for the elbow, wrist, and hand and at least 90 degrees of right shoulder motions with the therapist deferring assessment above 90 degrees to prevent overstretching of the shoulder. There is active motion of the right upper trapezius but no active shoulder abduction, external rotation, or elbow or wrist extension. The therapist instructs the family on gentle passive ROM, dressing, positioning, and handling of the affected side and recommends weekly physical therapy.
Delivery of anterior shoulder. (From DeCherney AH, Nathan L. Current Diagnosis & Treatment Obstetrics & Gynecology. 11th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Upper or Erb palsy (C5, C6, and/or C7) is the most common: Arm postured in shoulder adduction, internal rotation, neutral extension; elbow extension; forearm pronation; wrist and finger flexion.
Lower or Klumpke palsy (C8, T1) is rare: Hand is flaccid.
Total palsy (C5-T1): Arm and hand are involved.
SIGNS AND SYMPTOMS
Weakness of deltoid, biceps, brachioradialis, brachialis (Erb palsy)
Weakness of wrist flexors and finger intrinsics (Klumpke palsy)
All of the above plus sensory loss for total brachial plexus injury
Limits ability to use involved arm for reaching, grasping, or participating in ADLs
Inability to weight bear on involved arm
Inability to attain quadruped or crawl on hands and knees
Asymmetrical use ...
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