Alternative Names Erb's Palsy, Klumpke's paralysis
Definition Brachial palsy is a condition in an infant in which the arm is partly or completely paralysed.
What is going on in the body? Brachial palsy is a birth injury that can happen to newborns as the head and shoulders are being delivered. The brachial plexus is a network of nerves that join together to form the nerves of the arm, hand, and fingers. If the brachial plexus is stretched during delivery, the newborn may have weakness or paralysis involving all or part of an arm.
What are the signs and symptoms of the condition? A newborn with brachial palsy holds the affected arm close to the body. The elbow is not bent and the hand is turned palm down. The infant cannot move the affected arm. Sometimes only the upper part of the arm is affected and the baby can move the hand and fingers. Often the entire arm, including the hand and fingers, is affected.
What are the causes and risks of the condition? The injury is more likely to happen if the baby is large and the bony outlet of the mother's pelvis is small, relative to the baby. The brachial plexus can be stretched if the person assisting in the delivery has to pull on the baby's head and neck in order to deliver the shoulders. It can also happen with breech delivery, if the baby's arms are extended above his or her head during the delivery.
What can be done to prevent the condition? It is not easy to predict whether there is going to be difficulty delivering the baby's shoulders. If the mother is known to have a small pelvic outlet and to be carrying a large baby, the infant may be delivered by caesarean section.
How is the condition diagnosed? The doctor can generally diagnose brachial palsy by observing the infant's arm position and movement. The doctor may order an x-ray, CT scan, or MRI scan if a collarbone fracture is suspected.
What are the long-term effects of the condition? The long-term effects of brachial palsy will vary, depending on the degree of damage to the brachial plexus. If mild damage had occurred, the symptoms may improve within several days to 6 months. If severe damage has occurred to the nerve, permanent paralysis may occur.
What are the risks to others? Brachial palsy is not contagious and poses no risk to others.
What are the treatments for the condition? If the injury to the nerves is mild, arm and hand function usually returns after several months. If the nerves are actually torn, normal function may never be recovered. Fortunately, injuries of this severity are rare. If it appears that nerve function is not returning quickly, the arm and hand can be placed in splints while the infant is sleeping to maintain the normal joint function. Range of motion exercises may be recommended to keep muscles strong and active.
What are the side effects of the treatments? Splints can cause skin irritation or rash. Surgery poses a risk for bleeding, infection, and allergic reaction to anaesthesia.
What happens after treatment for the condition? A child who has full recovery from brachial palsy will need no further treatment. A child who has mild to moderate nerve damage may need physiotherapy to improve use of the arm and hand. A child who has full paralysis may need periodic physiotherapy to get used to using different equipment.
How is the condition monitored? Brachial palsy can best be monitored by the caregiver and, as the child gets older, by the child. Any new or worsening symptoms should be reported to the doctor.
Author: Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
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