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Eloisa L. Flores MD

Smellie reported the case of an infant with bilateral arm weakness that resolved spontaneously within a few days after birth. 1870s .   1779 . attributing the findings to traction on the upper trunk In 1885.Duchenne and Erb described cases of upper trunk nerve injury. Klumpke described injury to the C8T1 nerve roots and the nearby stellate ganglion .

C6. and C7 levels. . Upper-middle trunk BPP involves nerve fibers from C5. Total BPP affects nerves at all levels (C5-T1). Klumpke palsy results in deficits at levels C8 and T1. although many clinicians agree that pure C8-T1 injuries do not occur in infants and may be indicative of spinal cord injury (SCI).Brachial Plexus     Erb's palsy affects nerves arising from C5 and C6.

These lesions generally are reversible and do not leave sequelae. Axonotmetic lesions . Neurotmetic lesions are the most severe. leading to degeneration of the axon distal to the injury.   . destroying not only the axon and myelin. but also the supporting structures across a nerve.Peripheral Nerve Injury  Purely neurapraxic lesions do not affect the axon itself.disruption of the myelin sheath and the axon.



specifically the upper trunk C5-C6 is severed. most common cause is dystocia it can occur if the infant's head and neck are pulled toward the side at the same time as the shoulders pass through the birth canal .Erb's palsy (Erb-Duchenne Palsy)    paralysis of the arm caused by injury to the upper group of the arm's main nerves.

average breech BPP.Risk Factors           Large birth weight (average vertex BPP. average unaffected. use of mid/low forceps.7 kg. 2.0 kg.8-4. vacuum extraction) Forceful downward traction on the head during delivery Previous child with OBPP Intrauterine torticollis Shoulder dystocia . 3.5 kg) Breech presentation Maternal diabetes Multiparity Second stage of labor that lasts more than 60 minutes Assisted delivery (eg. 1.8-5.8-3.

as is also supination of the forearm"." . the forearm is extended and pronated. "The position of the limb. biceps. The resulting biceps damage is the main cause of this classic physical position commonly called "waiter's tip. The arm cannot be raised from the side. all power of flexion of the elbow is lost. is characteristic: the arm hangs by the side and is rotated medially.Signs of Erb’s Palsy     loss of sensation in the arm and paralysis and atrophy of the deltoid. under such conditions. and brachialis muscles.


wrist.Treatment    most newborns with brachial plexus birth palsy recover on their own Daily physical therapy and range of motion exercises. The exercises will maintain the range of motion in the shoulder. done as often as possible during the day. elbow. and hand thus preventing joint contracture. begin when a baby is about 3 weeks old. .