Brachial Plexus Injuries By Tara Pingle
Brachial plexus injuries, also known as Erb’s Palsy, are injuries to the nerves in the shoulder area that usually occur at birth.
Brachial plexus injuries, also known as Erb’s Palsy, are injuries to the nerves in the shoulder area that usually occur at birth. These injuries, which affect the movement of a child’s shoulder, arm and hand, happen when the infant’s shoulders get stuck in the birth canal after the head emerges (shoulder dystocia), requiring techniques to free the child from the cervix which do not use traction. If excessive force is used, these measures may lead to significant injury for both mother and child. The pulling of the baby’s head stretches and injures the nerves in the shoulder that is impacted. This collection of nerves is called the brachial plexus or Erb’s Point, which is located in the upper trunk. In most cases these nerves are only stretched, and usually recover spontaneously within 3-4 months. Sometimes, as the nerves try to heal themselves, scar tissue is formed along the nerve that disrupts signals to the muscles. In other instances, the nerves are so severely injured that they are torn from the spine (avulsed), or they may be ruptured at a different place along the nerve. These situations result in varying degrees of paralysis of the arm and shoulder, and if surgical intervention is not conducted in a timely fashion, this paralysis may be permanent.
Brachial plexus injury may result in various degrees of weakness. The part of the arm that is involved directly correlates to the nerves that may be damaged in the upper trunk (generally C5, C6), middle trunk (generally C7) or lower trunk (Klumpke’s Palsy generally C8, T1). Babies with this type of injury will have limp arms by their sides, with forearms turned inward and wrists bent. The affected babies cannot lift their arm, and may also have droopy eyelids (Horner’s Syndrome) on the side that was injured.
In most cases, brachial plexus injuries are preventable, and it is important for the mother to receive regular prenatal care with dietary vigilance. High blood sugars over-nourish babies and make them gain weight faster than normal, and larger babies are more likely to get stuck in the birth canal. This is why diabetic mothers or mothers with gestational diabetes are more likely to have these high risk deliveries. Advanced planning with your physician during your pregnancy will help to anticipate a difficult delivery.
The manner in which the baby is delivered may also be a cause of Erb’s Palsy, even if there are no prenatal signs. The factors include excessive traction, fundal (stomach) pressure, limited or no episiotomy, and failure to use the appropriate maneuver to free the baby’s shoulder.
Some prenatal risk factors are:
· Mothers with a small pelvis
· Previous history of shoulder dystocia
· Prolonged labors
· Induced labors
· Breech deliveries
· Fetal malposition
· Mothers with diabetes or gestational diabetes
As a result, a caesarean section may be indicated, but may not always be the first choice of your health care provider. Caesarean sections have their own inherent complications, such as hemorrhage, infection; pulmonary embolism, adhesions; intestinal obstruction, bladder injury; uterine rupture, higher incidence of ectopic pregnancies (future); and placenta praevia.
Article Provided by
National Rehabilitation Information Center