- Erb’s palsy
- Klumpke’s palsy
- Brachial plexus injury
- Birth brachial plexus injury
- Traumatic injury to the brachial plexus caused during delivery of an infant
- Stretch or incomplete rupture of the plexus is the most common injury often resulting from vacuum or forceps delivery4
- 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
- About 1.5 per 1,000 infants4
- 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
- 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
Possible Contributing Causes
- Traction on the shoulder with or without cervical rotation
- Large birth weight
- Breech presentation5
- Shoulder dystocia5
- Spinal cord injury
- Cerebral palsy
- Standard radiograph of arm and chest
- CT scan
- Surgery for nerve, tendon, or muscle transfers
- Botox injections to antagonist muscles
- Occupational therapist
- Decreased strength
- Decreased ROM
- Asymmetrical in and/or delay of gross motor skills
- No ROM for 7 to 10-day-old infant5
- Avoid lying on affected side
- Avoid picking infant up under axilla
- Gentle, pain free passive range of motion
- Parent/caregiver education
- Serial casting
- Stabilize scapula during ROM and activities
- Facilitate developmental activities
- 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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