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Erb's Palsy, Causes, Diagnosis, Treatment, Prevention, Complications

Erb's palsy is an injury to the nerves of the shoulder that usually occurs in newborns. Generally, this condition occurs due to obstructed or breech labor. Erb's palsy can cause weakness or paralysis of the shoulder and arm on the side of the affected nerve. Erb's palsy is also known as Erb-Duchenne palsy or brachial plexus injury. Cases of Erb's palsy occur in 1-2 babies out of every 1,000 births. If left unchecked, this condition can cause a permanent decrease in nerve function. 

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Erb's Palsy, Causes, Diagnosis, Treatment, Prevention, Complications

Although it usually occurs in newborns, Erb's palsy can also occur in children and adults. Erb's palsy in children or adults most often occurs as a result of an accident or injury.

Causes of Erb's Palsy

Erb's palsy results from an injury to the brachial plexus. The brachial plexus is a collection of nerves that runs from the neck to the shoulders. This collection of nerves originates from branches of the neck nerves, namely nerves C5, C6, C7, C8, and T1.

Based on the severity of the injury, Erb's palsy can be divided into four types, namely:

  • Neuropraxia
  • Neuropraxia is the mildest type of brachial plexus nerve injury. This type occurs when the nerves of the brachial plexus are stretched but not torn. Neuropraxia usually occurs when a nerve root is stretched, for example when the head is pushed to one side.
  • Neuromas
  • Neuroma is the formation of scar tissue from damaged nerves that have healed. The formation of a neuroma can interfere with the passage of nerve signals so that their function is disrupted.
  • rupture
  • In this type, the nerves of the brachial plexus stretch so strongly that it causes a tear, either a partial or complete tear. In contrast to an avulsion, this tear occurs not in the nerve root. However, this type is more severe than neuropraxia and usually requires surgery.
  • Avulsion
  • Avulsion is the most severe type of injury. In this type, the tear occurs very close to the brachial plexus nerve root in the neck. Avulsions generally occur as a result of a serious injury, such as a car accident.

Erb's palsy risk factors

In newborns, there are several factors that can increase the risk of Erb's palsy, namely:

  • Large baby (macrosomia)
  • The baby is in a breech position during labour, which can also occur with multiple pregnancies
  • Long labor or shoulder dystocia
  • Mother has diabetes
  • The mother experiences many contractions during labor (uterine tachysystole), usually due to drug induction of labor
  • The use of oxytocin, which is a hormone to trigger contractions

Apart from newborns, there are also several factors that can increase the risk of Erb's palsy in adults, namely:

  • fell
  • Getting hit or bumped into something
  • Having an accident while driving, especially a motorcycle accident
  • Has a gunshot or stab wound in the shoulder area

Symptoms of Erb's Palsy

The nerves in the brachial plexus carry signals that are given by the brain to the shoulder and arm. Erb's palsy causes the function of these nerves to be disrupted so that signals from the brain do not reach the shoulders and arms. As a result, one of the baby's shoulders and arms is weak or paralyzed so that it appears motionless.

Meanwhile, in children and adults, some of the symptoms that can occur in the affected shoulder and arm are:

  • Weak or paralyzed
  • The arms droop with the fingers curled inward
  • Tingling or numbness
  • Pain and burning sensation

If the injury occurs to the nerves of the brachial plexus near the neck, both adults and newborns can experience signs of Horner's syndrome, namely:

  • The eyelids and hands on the affected side droop
  • The pupil of the eye on the affected side of the shoulder narrows
  • The face and shoulder on the affected side do not sweat (anhidrosis)

When to see a doctor

In most cases, Erb's palsy in newborns can be detected through examination by a doctor after the baby is born. The doctor will carry out further examinations and treatment if the baby has this condition.

If you or your child experience the complaints above, immediately do an examination to the doctor. Handling Erb's palsy must be done immediately within a maximum period of 6 months since the injury occurred. This is because the success rate of treatment, especially surgery, can be drastically reduced if it is not done within that time.

Diagnosis of Erb's Palsy

To diagnose Erb's palsy, the doctor will ask about the patient's symptoms and medical history. After that, the doctor will carry out a physical and neurological examination, including checking the reflexes on the affected arm.

The doctor can also carry out several supporting examinations to confirm the diagnosis, for example:

  • X-rays of the neck and shoulders, to detect fractures or other injuries to the bones and tissues around the shoulders and neck
  • Scanning with MRI or CT myelography, to see the condition of the nerves and muscles in the body, and detect abnormalities in the nerves and muscles
  • Electromyography, to find out how well the nerves flow to the muscles

Treatment of Erb's Palsy

Erb's palsy treatment is based on the severity of the condition. In patients who have mild Erb's palsy, such as neuropraxia, special treatment is generally not needed. Patients can recover by themselves in a matter of weeks or months.

To accelerate and optimize healing, the doctor will suggest physical therapy (physiotherapy) and rehabilitation to improve range of motion and muscle strength. Physiotherapy and rehabilitation can be started after the baby is 3 weeks old.

When they are older, doctors will advise children born with Erb's palsy to regularly do sports that involve both arms, such as swimming and playing basketball.

If physiotherapy and rehabilitation for 3−6 months are not effective in treating Erb's palsy, the doctor may suggest surgery. While in adults, surgery should be done no later than 6 months after the injury occurred.

Some of the types of surgery that can be performed are:

  • Nerve repair surgery, by reconnecting the two torn nerve endings
  • Nerve graft surgery, either from the body itself (nerve graft) or from another person (Oberlin transfer)
  • Muscle, bone and tendon repair surgery, if a severe injury causes damage to the muscles, bones and tendons of the shoulder, or if treatment for Erb's palsy is delayed
  • Neurolysis, to remove the neuroma

Apart from doing physiotherapy and surgery, doctors can also perform other therapies, namely:

  • Occupational therapy, to train skills in dressing or doing other daily activities after surgery
  • Botox injections, to improve the function of the shoulder muscles and reduce stiffness in the shoulder muscles
  • Neuromuscular electrical stimulation (NMES), to stimulate nerves and improve muscle contractions

Erb's palsy complications

If left untreated, there are several complications of Erb's palsy that can arise, namely:

  • Limited range of motion of the affected shoulder and arm
  • Permanent numbness and paralysis of the affected shoulder and arm
  • Impaired balance and coordination
  • Scoliosis
  • Changes in the shape of the shoulder bones
  • Shoulder dislocation

Prevention of Erb's Palsy

Several things can be done to reduce the risk of Erb's palsy in newborns, namely:

  • Control blood sugar and take medication regularly to reduce the risk of babies being born with macrosomia, especially in mothers who have gestational diabetes.
  • Do routine pregnancy checks, especially if you are pregnant with twins, have a breech fetus, or have a history of babies with shoulder dystocia in previous births.
  • Maintain ideal body weight before pregnancy.
  • Maintain ideal weight gain during pregnancy.

In addition to some of the things above, the risk of Erb's palsy in children or adults can also be reduced by using protective equipment when exercising or driving, to avoid injury due to accidents.

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