its a paralysis of the arm caused by injury to the brachial plexus, specifically the upper brachial plexus or erb’s point. It is the most common birth related neuropraxia (about 52%).
It is a lesion of C5 & C6 nerve roots usually produced by widening of the head shoulder interval (in some cases C7 is involved as well).
Mechanism of Injury or Pathological Process:
- an abnormal or difficult childbirth or labor
- clavicle fracture unrelated to dystocia.
- following trauma to the head and shoulder, which cause the nerves of the plexus to violently stretch
- direct violence, including gunshot wounds and traction on the arm, or attempting to diminish shoulder joint dislocation
Clinical Presentation
- Affected nerves are the axillary nerve, musculocutaneous, & suprascapular nerve
- Muscles most often paralyzed are supraspinatus and infraspinatus because the suprascapular nerve is fixed at the suprascapular notch (Erb’s point)
- In more severely affected patients deltoid, biceps, brachialis, and subscapular is affected (C5 and C6)
- The arm cannot be raised, since deltoid (axillary nerve ) & spinati muscles (suprascapular nerve) are paralyzed
- Elbow flexion is weakened because of weakness in biceps & brachialis
- If roots are damaged above their junction, paralysis of rhomboids and serratus anterior is added, producing weakness in retraction and protraction of scapula
Physiotherapy Management
During the first 6 months treatment is directed specifically at prevention of fixed deformities. Exercise therapy should be administered daily to maintain ROM and improve muscle strength. Parents must be taught to take an active role in maintaining ROM and keeping the functioning muscles fit.
- Activities and exercises to promote recovery of movement and muscle strength
- Exercises to maintain range of movement in the joints to prevent stiffness and pain
- Exercises to promote increased awareness of the arm
- Provision of splints to prevent secondary complications and maximise function
- Advising parents on appropriate handling and positioning of the child and home exercises to maximise the child’s potential for recovery
- Referral to Occupational Therapy for assessment of function in day to day activities
- Constraint induced movement therapy may be useful