Erb–Duchenne palsy

Erb–Duchenne Palsy

Erb–Duchenne palsy, also known as Erb's palsy, is a form of brachial plexus injury that primarily affects the upper arm and shoulder. It is named after Wilhelm Erb and Guillaume Duchenne, who were among the first to describe the condition in the 19th century.

Pathophysiology

Erb–Duchenne palsy results from injury to the upper trunk of the brachial plexus, specifically the C5 and C6 nerve roots. This injury can occur during childbirth, particularly in cases of shoulder dystocia, where the infant's shoulder becomes lodged against the mother's pubic bone. Excessive lateral traction on the head during delivery can stretch or tear the nerves, leading to the characteristic symptoms of the condition.

Clinical Presentation

Patients with Erb–Duchenne palsy typically present with a characteristic posture known as "waiter's tip". This includes:

• Adduction and internal rotation of the shoulder
• Extension and pronation of the forearm
• Flexion of the wrist and fingers

The affected arm may have limited movement and strength, and the biceps reflex is often absent. Sensory deficits may also be present in the lateral aspect of the arm.

Diagnosis

Diagnosis of Erb–Duchenne palsy is primarily clinical, based on the characteristic posture and history of birth trauma. Electromyography (EMG) and nerve conduction studies can be used to assess the extent of nerve damage. Magnetic resonance imaging (MRI) may be employed to visualize the brachial plexus and rule out other causes of arm weakness.

Management

Management of Erb–Duchenne palsy involves both non-surgical and surgical approaches:

Non-Surgical

• Physical therapy: Early intervention with physical therapy is crucial to maintain joint mobility and prevent contractures.
• Occupational therapy: Helps in improving functional use of the affected arm.

Surgical

• Nerve grafting: In cases where there is no improvement with conservative management, surgical intervention such as nerve grafting may be considered.
• Tendon transfers: To improve function, tendon transfers may be performed to compensate for paralyzed muscles.

Prognosis

The prognosis for Erb–Duchenne palsy varies depending on the severity of the injury. Many infants recover fully with conservative management, but some may have persistent weakness or functional limitations. Early intervention and rehabilitation are key to improving outcomes.

Also see

• Brachial plexus injury
• Klumpke's palsy
• Shoulder dystocia
• Physical therapy