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Condition/Disorder Synonyms

  • Erb's palsy

  • Klumpke's palsy

  • Brachial plexus injury

  • Birth brachial plexus injury

ICD-9-CM Code1

ICD-10-CM Codes2

Preferred Practice Pattern3

Key Features

Description

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

Essentials of Diagnosis

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

General Considerations

  • 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

Demographics

  • About 1.5 per 1,000 infants4

Clinical Findings

Signs and Symptoms

  • 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

Functional Implications

  • 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

  • Compression

  • Traction on the shoulder with or without cervical rotation

  • Avulsion

  • Large birth weight

  • Breech presentation5

  • Shoulder dystocia5

Differential Diagnosis

  • Spinal cord injury

  • Stroke

  • Cerebral palsy

Means of Confirmation or Diagnosis

Imaging

  • Standard radiograph of arm and chest

  • CT scan

  • MRI

Diagnostic Procedures

  • EMG

Treatment

Medical Procedures

  • Surgery for nerve, tendon, or muscle transfers

  • Botox injections to antagonist muscles

Referrals/Admittance

  • Neurologist

  • Orthopedist

  • Occupational therapist

Impairments

  • Decreased strength

  • Decreased ROM

  • Asymmetrical in and/or delay of gross motor skills

Tests and Measures

Intervention

  • No ROM for 7 to 10-day-old infant5

  • Avoid lying on affected side

  • Avoid picking infant up under axilla

  • Splinting

  • Gentle, ...

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