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Incidence of Erb's Palsy?
Most common birth related neuropraxia. .5-2 per 1000 live births. Formally diagnosed with MRI.
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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)
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Posture clinical presentation of Erb's Palsy?
waiter's tip, shoulder IR and adduction, finger flexion, forearm pronation, scapular winging, posterior shoulder dislocation
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Decrease strength clinical presentation of Erb's Palsy?
decrease strength og deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, supinator.
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sensory loss clinical presentation of Erb's Palsy?
C5-C6 difficits.
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What activities do people with Erb's Palsy have difficulties with?
- hand-to-mouth
- hand-to-head
- hand-to-back
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Medical manifestations of Erb's Palsy?
- Flattening of the glenoid fossa/humeral head.
- elongation deformity of coracoid process hooking down and lateral.
- scoliosis.
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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.
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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
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End goal of PT management with patients with Erb's Palsy?
to perform age appropriate shelf-care skills and ADL
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PT interventions with patients with Erb's Palsy?
- positioning (kinesiotaping, theratogs, benik splints)
- neuromuscular ESTIM
- ROM (PROM, AROM, AAROM)
- biofeedback
- myofascial release
- joint mobilization
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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.
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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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