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Condition/Disorder Synonyms

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  • Erb-Duchenne palsy

  • Brachial plexus injury

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ICD-9-CM Codes

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  • 767.6 Injury to brachial plexus due to birth trauma

  • 953.4 Injury to brachial plexus

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ICD-10-CM Codes

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  • G54.0 Brachial plexus disorders

  • P14.0 Erb's paralysis due to birth injury

  • S14.3XXA Injury of brachial plexus, initial encounter

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Preferred Practice Patterns1

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Key Features

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Description

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  • Paralysis of the arm

  • Weakness in the arm

  • Diminished reflexes, C5-C6 vertebrae

  • Arm hangs by side, internally rotated

  • Motor or sensory changes in the nerve distribution due to pressure from compression and stretch

    • Sensory changes in multiple peripheral nerves of the upper extremity from C5 and C6 nerve roots

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Essentials of Diagnosis

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  • Seddon's classification

    • Neurapraxia (Class 1), 1st degree

    • Axonotmesis (Class 2), 2nd degree

    • Neurotmesis (Class 3)

      • 3rd degree, nerve fiber interruption

      • 4th degree, epineurium intact

      • 5th degree, complete transection of the nerve

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General Considerations

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  • Involved nerves include suprascapular, musculocutaneous, axillary

  • Must differentiate from more proximal and distal nerve compression, thoracic outlet syndrome (TOS), ulnar tunnel, cervical radiculopathy

  • Wallerian degeneration occurs below site of injury

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Clinical Findings

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Signs and Symptoms

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  • Acute or chronic paresthesia

  • Sensory changes: hyposensitivity of hand

  • Hand clumsiness

  • Feeling of arm heaviness

  • Hand weakness, loss of grip-power and dexterity

  • Intrinsic muscle atrophy

  • Waiter's tip sign

  • Loss of lateral-rotator, arm-flexor, and wrist-extensor musculature

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Functional Implications

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  • Feeling of arm being dead

  • Difficulty with hand function, hand clumsiness, and possible loss of strength during ADLs/IADLs

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Possible Contributing Causes

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  • During forceps delivery, infant has head traction

  • In the womb, sustained pressure over thoracic outlet

  • Falls with outstretched arms

  • Traction to the cervical spine

  • Trauma pulling arm into abduction

  • Ganglion or space-occupying lesion

  • Clavicle fracture

  • Glenohumeral dislocation

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Differential Diagnosis

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  • Thoracic outlet syndrome (TOS)

  • Cervical radiculopathy

  • Other potential entrapment sites include

    • Medial humeral groove

    • Arcade of Struthers

    • Medial intermuscular septum

    • Flexor digitorum profundus

    • Flexor carpi ulnaris

    • Just proximal to or within Guyon's canal

    • Sensory and motor involvement between the abductor digiti minimi and flexor digiti minimi

    • Near hook of hamate: involves motor function only

    • Distal end of Guyon's canal: involves sensory function only

  • Radial neuropathy

  • Median neuropathy

  • Carpal tunnel syndrome

  • Proximal ulnar nerve entrapment

  • Distal ulnar nerve entrapment cubital tunnel (Guyon's Canal)

  • Klumpke paralysis

    • Traction of an abducted arm

    • Lower brachial plexus injury

    • Damage to C8 and T1 vertebrae

    • Loss of intrinsic muscles of the hand, wrist, finger flexors

  • Ulnar nerve ...

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