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Erb’s Palsy in a Newborn Child and Clinicoanatomical Approach

Received: 5 January 2021    Accepted: 18 January 2021    Published: 2 February 2021
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Abstract

Erb’s palsy is found in upper trunk of brachial plexus. C5, C6 roots join to from upper trunk. Each trunk again divides into anterior and posterior divisions. All trunks and divisions are found above the clavicle in the posterior triangle of neck. Branches from the upper trunk are suprascapular nerve and nerve to subclavius. Suprascapular nerve supplies supraspinatus and infraspinatus muscle along with it a articular trig to capsule of shoulder joint. Supraspinatus helps in initial 15 ºabduction at shoulder joint. Infraspinatus acts as lateral rotator of shoulder joint and assists subscapularis and teres minor muscles to abduct at this joint when there is contraction of middle fibers of deltoid and supraspinatus. Some fibers of C5 also give contribution to accessory phrenic nerve. Lateral cord of brachial plexus giving– musculocutaneous nerve, lateral pectoral nerve, lateral root of median nerve. Musculocutaneous nerve supplies all flexor muscles of arm like biceps brachii, brachialis, coracobrachialis. Brachialis muscle flexes the elbow joint, coracobrachialis is a weak flexor of shoulder joint and biceps brachii is a strong supinator of forearm, flexor of elbow joint only when forearm is supinated. Injury occurs in the Erb’s point found in the upper trunk of brachial plexus where there are emergence of six branches- C5 & C6 nerve roots, suprascapular nerve, nerve to subclavius, anterior and posterior division of upper trunk of the plexus. In this palsy, the arm remains medially rotated and adducted at the shoulder joint, the elbow is extended or semiflexed, forearm is pronated, and the wrist semiflexed. In this case a newborn child was found unable to flex his elbow, and abducted the arm on the right side. The limb is medially rotated, adducted in shoulder joint, semiflexion at the elbow joint and forearm pronated and wrist semiflexed. The child was kept on artificial respiratory ventilation. Plain Chest X-ray done to see if any musculoskeletal abnormality is there but no positive findings found so far. Both the clavicles and all ribs were found intact. Both domes of diaphragm were moving normally. On the other hand left sided upper limb found fully flexed at the elbow joint, supinated at forearm, abducted externally rotated at the shoulder joint and wrist extended. Moros reflex on the right side was absent but on left side it was clearly present. So, there is asymmetrical Moros reflex.

Published in Biomedical Sciences (Volume 7, Issue 1)
DOI 10.11648/j.bs.20210701.13
Page(s) 17-19
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Erbs, Brachial, Clavicle, Fracture, Moros, Elbow, Injury, Arm

References
[1] https://accessanesthesiology.mhmedical.com
[2] MR Thatte, A Hiremath, N Nayak, N Patel. Obstetric Brachial Plexus Palsy. Diagnosis and Management Strategy. Journal of Peripheral Nerve Surgery. Vol- 1, (1) 2017 pg: 2-9.
[3] Erb-Duchenne and Dejerine-Klumpke Palsies Information Page: National Institute of Neurological Disorders and Stroke (NINDS).
[4] Raducha JE, Cohen B, Blood T, Katarincic J. A review of brachial plexus birth palsy: Injury and rehabilitation. Rhode Island Medical Journal. 2017 Nov 1; 100 (11): 17-21.
[5] Mohammad M. Al-Qattan & Amel A. F. El-Sayed. A case of Klumpke’s obstetric brachial plexus palsy following a Cesarean section. Clinical case report. 2016 Sep; 4 (9): 872–875.
[6] https://europepmc.org/article/med/31194330
[7] Fátima Frade, Juan Gómez-Salgad, Lia Jacobsohn and Fátima Florindo-Silva. Rehabilitation of Neonatal Brachial Plexus Palsy: Integrative Literature Review. J. Clin. Med. (2019) vol- 8 pg: 980.
[8] Deepak Sharma, Aakash Pandita, Sweta Shastri, Pradeep Kumar Sharma. Duchenne-Erb’s palsy in newborn: Result of birth trauma Medical Journal of Dr. D. Y. Patil University | March-April 2016 Vol 9 (2).
[9] Bannister LH, Berry MM, Collins P, et al. Gray’s Anatomy, anatomical basis of anatomy and surgery. 38th ed. London: Churchill Livingstone;. p. 1266‒1267.
[10] Audra J. Reiter, Yazan K. Rizeq, Benjamin T. Many, Jonathan C. Vacek, Fizan Abdullah, and Seth D. Goldstein. A Rare Case of Contralateral Diaphragm Paralysis following Birth Injury with Brachial Plexus Palsy: A Case Report and Review of the Literature. Case Reports in Pediatrics. vol-2020 pg: 1-6.
[11] Jaspreet Johal, Joe Iwanaga, Kevin Tubbs, Marios Loukas, Red J. Oskouion, R. Shane Tubbs. The Accessory Nerve: A Comprehensive Review of its Anatomy, Development, Variations, Landmarks and Clinical Considerations (2019) The anatomical record vol-302 pg: 620–629.
[12] M. C McGrath. The Vulcan Nerve Pinch - Cultural Iconography Anchors the Proposal of a Novel Manual Approach, the Bow-String Technique. Int J Complement Alt Med 2017, 5 (5): pg-1-8.
[13] Dr. Ian Bickle, Craig Hacking. Punctum nervosum. https://radiopaedia.org/articles/punctum-nervosum. 7 January 2021.
[14] Laxmi Kokatnur. ID and Mohan Rudrappa. Diaphragmatic Palsy. Diseases 2018, vol-6 (16). pg-1-14.
[15] A. Abid. Brachial plexus birth palsy: Management during the first year of life. Orthopaedics & Traumatology: Surgery & Research. vol-102 (2016) S125–S132.
[16] https://www.intechopen.com/books/treatment-of-brachial-plexus-injuries/current-concept-in-the-management-of-brachial-plexus-birth-palsy.
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  • APA Style

    Debajani Deka. (2021). Erb’s Palsy in a Newborn Child and Clinicoanatomical Approach. Biomedical Sciences, 7(1), 17-19. https://doi.org/10.11648/j.bs.20210701.13

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    ACS Style

    Debajani Deka. Erb’s Palsy in a Newborn Child and Clinicoanatomical Approach. Biomed. Sci. 2021, 7(1), 17-19. doi: 10.11648/j.bs.20210701.13

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    AMA Style

    Debajani Deka. Erb’s Palsy in a Newborn Child and Clinicoanatomical Approach. Biomed Sci. 2021;7(1):17-19. doi: 10.11648/j.bs.20210701.13

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  • @article{10.11648/j.bs.20210701.13,
      author = {Debajani Deka},
      title = {Erb’s Palsy in a Newborn Child and Clinicoanatomical Approach},
      journal = {Biomedical Sciences},
      volume = {7},
      number = {1},
      pages = {17-19},
      doi = {10.11648/j.bs.20210701.13},
      url = {https://doi.org/10.11648/j.bs.20210701.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.bs.20210701.13},
      abstract = {Erb’s palsy is found in upper trunk of brachial plexus. C5, C6 roots join to from upper trunk. Each trunk again divides into anterior and posterior divisions. All trunks and divisions are found above the clavicle in the posterior triangle of neck. Branches from the upper trunk are suprascapular nerve and nerve to subclavius. Suprascapular nerve supplies supraspinatus and infraspinatus muscle along with it a articular trig to capsule of shoulder joint. Supraspinatus helps in initial 15 ºabduction at shoulder joint. Infraspinatus acts as lateral rotator of shoulder joint and assists subscapularis and teres minor muscles to abduct at this joint when there is contraction of middle fibers of deltoid and supraspinatus. Some fibers of C5 also give contribution to accessory phrenic nerve. Lateral cord of brachial plexus giving– musculocutaneous nerve, lateral pectoral nerve, lateral root of median nerve. Musculocutaneous nerve supplies all flexor muscles of arm like biceps brachii, brachialis, coracobrachialis. Brachialis muscle flexes the elbow joint, coracobrachialis is a weak flexor of shoulder joint and biceps brachii is a strong supinator of forearm, flexor of elbow joint only when forearm is supinated. Injury occurs in the Erb’s point found in the upper trunk of brachial plexus where there are emergence of six branches- C5 & C6 nerve roots, suprascapular nerve, nerve to subclavius, anterior and posterior division of upper trunk of the plexus. In this palsy, the arm remains medially rotated and adducted at the shoulder joint, the elbow is extended or semiflexed, forearm is pronated, and the wrist semiflexed. In this case a newborn child was found unable to flex his elbow, and abducted the arm on the right side. The limb is medially rotated, adducted in shoulder joint, semiflexion at the elbow joint and forearm pronated and wrist semiflexed. The child was kept on artificial respiratory ventilation. Plain Chest X-ray done to see if any musculoskeletal abnormality is there but no positive findings found so far. Both the clavicles and all ribs were found intact. Both domes of diaphragm were moving normally. On the other hand left sided upper limb found fully flexed at the elbow joint, supinated at forearm, abducted externally rotated at the shoulder joint and wrist extended. Moros reflex on the right side was absent but on left side it was clearly present. So, there is asymmetrical Moros reflex.},
     year = {2021}
    }
    

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    AB  - Erb’s palsy is found in upper trunk of brachial plexus. C5, C6 roots join to from upper trunk. Each trunk again divides into anterior and posterior divisions. All trunks and divisions are found above the clavicle in the posterior triangle of neck. Branches from the upper trunk are suprascapular nerve and nerve to subclavius. Suprascapular nerve supplies supraspinatus and infraspinatus muscle along with it a articular trig to capsule of shoulder joint. Supraspinatus helps in initial 15 ºabduction at shoulder joint. Infraspinatus acts as lateral rotator of shoulder joint and assists subscapularis and teres minor muscles to abduct at this joint when there is contraction of middle fibers of deltoid and supraspinatus. Some fibers of C5 also give contribution to accessory phrenic nerve. Lateral cord of brachial plexus giving– musculocutaneous nerve, lateral pectoral nerve, lateral root of median nerve. Musculocutaneous nerve supplies all flexor muscles of arm like biceps brachii, brachialis, coracobrachialis. Brachialis muscle flexes the elbow joint, coracobrachialis is a weak flexor of shoulder joint and biceps brachii is a strong supinator of forearm, flexor of elbow joint only when forearm is supinated. Injury occurs in the Erb’s point found in the upper trunk of brachial plexus where there are emergence of six branches- C5 & C6 nerve roots, suprascapular nerve, nerve to subclavius, anterior and posterior division of upper trunk of the plexus. In this palsy, the arm remains medially rotated and adducted at the shoulder joint, the elbow is extended or semiflexed, forearm is pronated, and the wrist semiflexed. In this case a newborn child was found unable to flex his elbow, and abducted the arm on the right side. The limb is medially rotated, adducted in shoulder joint, semiflexion at the elbow joint and forearm pronated and wrist semiflexed. The child was kept on artificial respiratory ventilation. Plain Chest X-ray done to see if any musculoskeletal abnormality is there but no positive findings found so far. Both the clavicles and all ribs were found intact. Both domes of diaphragm were moving normally. On the other hand left sided upper limb found fully flexed at the elbow joint, supinated at forearm, abducted externally rotated at the shoulder joint and wrist extended. Moros reflex on the right side was absent but on left side it was clearly present. So, there is asymmetrical Moros reflex.
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Author Information
  • Silchar Medical College and Hospital, Silchar, Assam, India

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