Erb's Palsy / Erbs's Paralysis
Erb's paralysis, also known as Erb-Duchenne paralysis, is a condition that affects the brachial plexus, a network of nerves that controls movement and sensation in the shoulder, arm, and hand. The condition is named after Wilhelm Erb and Guillaume Duchenne, who described it in the late 19th century.
Erb's paralysis is typically caused by a traumatic injury to the brachial plexus during childbirth, but it can also result from a fall or other types of trauma. The injury often occurs when the infant's head and neck are pulled to one side during a difficult delivery. The most common symptoms of Erb's paralysis are weakness or paralysis of the shoulder and upper arm, numbness or tingling in the affected area, and a lack of reflexes in the affected arm.
Treatment for Erb's paralysis usually involves physical therapy and, in some cases, surgery. Physical therapy can help improve muscle strength and range of motion, and may include exercises and stretches to help retrain the muscles of the affected arm. In more severe cases, surgery may be necessary to repair or replace damaged nerves.
While the majority of infants with Erb's paralysis will eventually recover some or all of their movement and sensation in the affected arm, some may experience long-term weakness or disability. It is important for parents and caregivers of infants with Erb's paralysis to seek medical attention as soon as possible in order to ensure the best possible outcome.
Erb's paralysis is caused by an injury to the brachial plexus, a network of nerves that originates in the spinal cord and provides motor and sensory innervation to the shoulder, arm, and hand. The brachial plexus is formed by the joining of the nerve roots of the spinal cord that arise from the lower cervical and upper thoracic segments.
The injury to the brachial plexus that causes Erb's paralysis is typically a result of excessive stretching or tearing of the nerve fibers that comprise the plexus. During childbirth, the baby's head and neck may be pulled to one side, causing stretching or tearing of the nerves in the brachial plexus.
The most commonly affected nerves in Erb's paralysis are the fifth and sixth cervical nerves, which form the upper trunk of the brachial plexus. These nerves control movement and sensation in the shoulder and upper arm.
The injury to the brachial plexus in Erb's paralysis can cause a range of symptoms, including weakness or paralysis of the shoulder and upper arm, numbness or tingling in the affected area, and a lack of reflexes in the affected arm.
The severity of the injury to the brachial plexus will determine the extent of the symptoms and the potential for recovery. Mild injuries may result in temporary weakness or discomfort, while more severe injuries may cause long-term disability.
Treatment for Erb's paralysis typically involves physical therapy to help improve muscle strength and range of motion. In some cases, surgery may be necessary to repair or replace damaged nerves in the brachial plexus.
In Erb's paralysis, the position of the affected upper limb may vary depending on the severity and extent of nerve damage. Generally, the affected arm will be adducted (pulled towards the body), internally rotated (turned inwards towards the body), and extended at the elbow, with the forearm pronated (turned downwards) and the wrist flexed (bent downwards). This position is also known as the "waiter's tip" position, as it resembles a waiter holding a tray.
The "waiter's tip" position is a result of the loss of innervation to the muscles that control shoulder abduction, external rotation, and elbow flexion. The affected arm is unable to move away from the body or rotate outwards, resulting in the adducted and internally rotated position. Additionally, the loss of innervation to the muscles that control forearm supination (turning upwards) and wrist extension results in the pronated and flexed position of the forearm and wrist.
The "waiter's tip" position is a common clinical finding in infants with Erb's paralysis, and can be used to help diagnose the condition. However, it is important to note that not all cases of Erb's paralysis will present with this specific positioning, and the extent of nerve damage and resulting symptoms may vary.
References:
American Academy of Orthopaedic Surgeons. (2021). Erb's Palsy (Brachial Plexus Birth Palsy). https://orthoinfo.aaos.org/en/diseases--conditions/erbs-palsy-brachial-plexus-birth-palsy/
Terzis, J.K., & Kokkalis, Z.T. (2017). Nerve Surgery. Thieme Medical Publishers.
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