#2 PARAYLSIS OBSTETRICA/ OBSTETRIC PALSY/ OCPP

Question 1

What is Obstetric Palsy?

Answer 1

• It’s the RESULT of a DIFFICULT BIRTH, when PULLING of the exiting arm out of the Vagina, or by Forceps

Leading to

• Hyper-extension of the Brachial Plexus
• Partial Tearing of the Plexus
• Formation of Hematoma in / around the plexus, affecting C5 - C7 Nerves

Question 2

What are the 3 TYPES of Obstetric Palsy?

Answer 2

1) ERB’s Palsy (Upper)

2) Klumpke’s Palsy (Lower)

3) Total Palsy (Complete)

Question 3

What is ERB’s Palsy (Upper)?

Answer 3

• It’s the INJURY to the Upper Trunk of the Brachial Plexus (C5 - C6)
• Presenting w/ muscle weakness in C5 / C6 myotomes = Flexed Wrist / Extended Forearm / Internally Rotated + Adducted Arm

Question 4

Where are the Areas of Weakness due to, ERB’s Palsy?

Answer 4

WEAKNESS in the:

• Biceps Brachii / Brachialis / Brachioradialis = Impaired Flexion / Supination of the Forearm; Absent Bicep Reflex
• Infraspinatus = Impaired External Rotation of Arm
• Deltoid / Supraspinatus = Impaired Arm Abduction
• Wrist Extensors = Impaired Wrist Extension

Question 5

What is Klumpke’s Palsy (Lower)?

Answer 5

• Injury to the LOWER Trunk of the Brachial Plexus (C8 - T1)
• Presenting w/ muscle weakness in C8/ T1 myotomes = Total Claw Hand
• Also Sensory Loss in C8/ T1 dermatomes = Little Finger + Medial Surface of Forearm
• Involving T1 = Horner’s Syndrome
• ABSENT Grasp Reflex = In Infants
• Hypotrophy + Hypoesthesia, of Thenar / Hypothenar

Question 6

What is Total Palsy (Complete)?

Answer 6

• COMBINATION of BOTH Types
• There’s Complete Palsy of the arm = Flaccid Arm
• Horner’s Syndrome = Miosis / Partial Ptosis / Anhidrosis

Question 7

What is the TREATMENT for Obstetric Palsy?

Answer 7

1) Treating, ERB’s Palsy (Upper)

• Arm is held over the head in abduction
• With elbow flexed at 90 + Forearm in Supination
• Position is kept in plaster / cardboard splint, for months

2) Treating, Klumpke’s Palsy (Lower)

• Splinting the hand = To CORRECT the Claw Hand