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  • Erb’s palsy
  • Klumpke’s palsy
  • Brachial plexus injury
  • Birth brachial plexus injury

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Description

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  • Traumatic injury to the brachial plexus caused during delivery of an infant

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Essentials of Diagnosis

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  • Stretch or incomplete rupture of the plexus is the most common injury often resulting from vacuum or forceps delivery4

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General Considerations

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  • Classifications
    • Upper or Erb’s 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’s palsy (C8, T1) is rare: hand is flaccid
    • Total palsy (C5-T1): arm and hand involved

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Demographics

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  • About 1.5 per 1,000 infants4

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Signs and Symptoms

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  • Weakness of deltoid, biceps, brachioradialis, brachialis (Erb’s palsy)
  • Weakness of wrist flexors and finger intrinsics (Klumpke’s palsy)
  • All of the above plus sensory loss for total brachial plexus injury

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Functional Implications

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  • Limits ability to use involved arm for reaching, grasping, or participating in ADLs
  • Inability to weight bear on involved arm
  • Inability to attain quadruped position or creep on hands and knees
  • Asymmetrical use of arms
  • Neglect of involved side

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Possible Contributing Causes

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  • Compression
  • Traction on the shoulder with or without cervical rotation
  • Avulsion
  • Large birth weight
  • Breech presentation5
  • Shoulder dystocia5

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Differential Diagnosis

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  • Spinal cord injury
  • Stroke
  • Cerebral palsy

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Imaging

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  • Standard radiograph of arm and chest
  • CT scan
  • MRI

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Diagnostic Procedures

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Medical Procedures

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  • Surgery for nerve, tendon, or muscle transfers
  • Botox injections to antagonist muscles

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  • Neurologist
  • Orthopedist
  • Occupational therapist

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  • Decreased strength
  • Decreased ROM
  • Asymmetrical in and/or delay of gross motor skills

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  • No ROM for 7 to 10-day-old infant5
  • Avoid lying on affected side
  • Avoid picking infant up under axilla
  • Splinting
  • Gentle, pain free passive range of motion
  • Parent/caregiver education
  • Serial casting
  • Stabilize scapula during ROM and activities
  • Facilitate developmental activities

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  • Increase strength in right biceps to at least 3/5 to allow for holding bottle with two hands within 6 months
  • Achieve prone position on elbows with weight bearing equally on both arms, to increase shoulder and scapular stability within 2 months
  • Reach up against gravity for a toy when in supine position to increase ...

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