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Klumpke paralysis; Erb-Duchenne paralysis; Erb's palsy
Brachial palsy is a loss of movement or weakness of the arm that occurs when the collection of nerves around the shoulder are damaged during birth.
This bundle of nerves is called the brachial plexus.
The nerves of the brachial plexus can be injured during a difficult delivery from:
There are different forms of brachial palsy in an infant. The type depends on the degree of arm paralysis:
The following increase the risk of brachial palsy:
Brachial palsy is less common now that delivery techniques have improved. Cesarean delivery is used more often when there are concerns about a difficult delivery.
Brachial palsy may be confused with a condition called pseudoparalysis. The infant has a fracture and is not moving the arm because of pain, but there has been no damage to the nerves.
Symptoms can be seen immediately or soon after birth, and may include:
A physical exam usually shows that the infant is not moving the upper or lower arm or hand. The affected arm may flop when the infant is rolled from side to side.
The Moro reflex is absent on the side with the brachial plexus or nerve injury.
A careful examination of the clavicle or collarbone will be done to look for a fracture. Sometimes, the infant will need to have an x-ray of this bone.
Gentle massage of the arm and range of motion exercises are recommended for mild cases. More severe cases may need to be evaluated by several specialists.
If some strength has not returned to the affected muscles by the time the baby is 3 - 6 months old, treatments may include:
A full recovery is expected in most cases. Most infants recover within 6 months, but those that do not recover have a very poor outlook.
The benefit of surgery to try to repair the nerves or compensate for the nerve deficit is not clear.
In cases of pseudoparalysis, the child will begin to use the affected arm as the fracture heals. Fractures in infants usually heal very quickly and easily.
Call your health care provider if your newborn shows a lack of movement of either arm.
Taking measures to avoid a difficult delivery, whenever possible, reduces the risk of brachial palsy in newborn babies.
Fenichel GM. Trauma and vascular disorders. In: Fenichel GM, ed. Neonatal Neurology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2006:chap 5.
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