On attempting a Moro's reflex it was asymmetrical with the right arm having little or no movement at all. While the baby was lying flat it was noticed that his right shoulder was adducted and internally rotated , the elbow was extended and pronated while the wrist was flexed. Brachial plexus damage and Erb's Palsy was suspected. The picture of the new born is shown below:
Case Discussion:
Erb's Palsy also know as Erb- Duchenne palsy is the paralysis of the arm caused by injury to the upper group of the arm's main nerves.
The brachial plexus is a network of nerves near the neck from which arises all the major nerves to the upper arm. Most commonly during a difficult labor and delivery the upper part of these nerves are damaged leading to paralysis of the arm.
Clinical Presentation: The presentation may be with a complete or a partial paralysis, depending upon the degree of the nerve damage. The most commonly involved nerve root is C5 , as this is mechanically the furthest point from the force of traction, therefore the first and t the most affected.
Erb's palsy presents as a lower motor neuron syndrome and the involved nerves include:
- suprascapular nerve
- musculocutaneous nerve
- axillary nerve.
The clinical signs include:
- The characteristic position of the arm is known as 'waiter's tip hand' in which the arm is adducted and internally rotated, the forearm is extended and pronated and the the wrist is flexed.
- In newborns the affected arm will show no movements on Moro's reflex.
Treatment: In mild cases, gentle massage and range of motion exercises are recommended. Some newborns may have spontaneous recovery after sometime, but in certain cases the problem my persist life long. Physiotherapy plays an important role to preserve muscle strength
In some cases neurosurgical intervention is needed if there is no improvement seen in the baby after 3-6 months. .
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