Erb's Palsy

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  1. Incidence of Erb's Palsy?
    Most common birth related neuropraxia. .5-2 per 1000 live births. Formally diagnosed with MRI.
  2. Cause of Erb's Palsy?
    • Injury to C5, C6 nerve roots, occasionally C4 from forceful traction of the newborn's shoulder.
    • greater risk of occurrence in difficult vaginal deliveries (newborns greater than 7.7 pounds, prolonged labor, maternal diabetes, sedated hypotonic infant, breech delivery)
  3. Posture clinical presentation of Erb's Palsy?
    waiter's tip, shoulder IR and adduction, finger flexion, forearm pronation, scapular winging, posterior shoulder dislocation
  4. Decrease strength clinical presentation of Erb's Palsy?
    decrease strength og deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, supinator.
  5. sensory loss clinical presentation of Erb's Palsy?
    C5-C6 difficits. 
  6. What activities do people with Erb's Palsy have difficulties with?
    • hand-to-mouth
    • hand-to-head
    • hand-to-back
  7. Medical manifestations of Erb's Palsy?
    • Flattening of the glenoid fossa/humeral head.
    • elongation deformity of coracoid process hooking down and lateral.
    • scoliosis.
  8. Medical management of Erb's Palsy?
    • Botox injections to manage contractures
    • microneurosurgical intervention, more severe cases not showing signs of spontaneous recovery. 3-4 months of age.
    • tendon transfers, plateau in recovery, 6-12 months of age. 
  9. PT management of Erb's Palsy?
    • Activities that encourage active and active assisted movements (want to maintain normal joint kinematics and prevent joint contractures)
    • shoulder mobility is critical to address scapulohumeral and scapulothoracic relationships. (Want to prevent shoulder subluxation and dislocation)
    • support and encourage spontaneous recovery and prevent secondary impairments (muscle asymmetry, gross motor delays) with bracing and positioning.
    • collaboration and coordination with OT 
  10. End goal of PT management with patients with Erb's Palsy?
    to perform age appropriate shelf-care skills and ADL
  11. PT interventions with patients with Erb's Palsy?
    • positioning (kinesiotaping, theratogs, benik splints)
    • neuromuscular ESTIM
    • biofeedback
    • myofascial release
    • joint mobilization 
  12. outcome of people with Erb's Palsy?
    most cases a full recovery is expected. recovery of shoulder ER is highly indicative of a good long term recovery. First muscles to return are elbow, wrist and finger extensors. Most of the time spontaneous recovery is seen by 9 months and full recover expected by 2 years of age. 
  13. Do all children recover from Erb's palsy?
    Most do HOWEVER, some children do have long term disabilities and recovery from motor control is poor after 18 months.
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Erb's Palsy
Erb's Palsy
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