Erb’s Palsy and Klumpke’s Paralysis
These conditions may result if there is trauma to the peripheral nerves and which will produce various neurologic manifestations. Generally, Erb’s palsy will result if the upper plexus and roots are injured and it is Klumpke’s paralysis if the lower plexus are involved.
Erb’ Palsy has the following characteristics:
- weakness of the injured arm is noted shortly after birth
- almost always, it is a one sided injury
- the arm assumes a characteristic posture wherein the shoulder is adducted and internally rotated, the elbow is extended, the forearm is pronated and the wrist is occasionally flexed
- Moro reflex is absent or diminished on the affected side
- GRASP REFlex is intact
- decreased pain sensation noted around the deltoid region
Clinically, the patient is managed wih gentle passive exercises of the arm. Over immobilization is being avoided since this may result to contractures and pathologic fractures.If improvement is not seen in 6 months , surgical exploration for nerve repair may be considered. Poor recovery usually means that the cause was avulsion of the nerve roots , and that surgery is to no avail.
Klumpke’s Paralysis, though relatively uncommon, involves the intrinsic muscles of the hands wih weakness of the wrist and finger flexors where:
- Grasp is absent
- unilateral Horner syndrome may be noted
- prognosis is generally poorer than that of Erb’s paralysis