Erb’s Palsy and Klumpke’s Paralysis Flashcards
Erb’s Paralysis
Erb-Duchenne Paralysis
CAUSES:
In children, birth trauma can cause this paralysis if the baby is pulled from the birth canal when the neck is extended, rotated and laterally flexed
In adults, cause is usually a trauma that violently separates the neck and shoulder. This can occur from a MVA or motorcycle accident if the person is thrown and lands on the head and shoulder
Sports accidents can result in similar violent fall which could traction these nerves
Erb’s Paralysis
SYMPTOM PICTURE:
Presentation of the arm and hand called “waiter’s tip” deformity with the shoulder adducted and internally rotated, the elbow extended, forearm pronated, and the wrist and fingers flexed
Muscle wasting and motor dysfunction affect all muscles above the elbow, especially shoulder abductors, external rotators and extensors, as well as forearm pronators and supinator’s, the muscles of the hand (especially intrinsic muscles) are not involved
Sensory loss involves the C5 and C6 dermatomes, especially over the radial surfaces of the forearm and hand and deltoid area
Tissue edema and dystrophy are not significant
Erb’s Paralysis
HEALTH HISTORY Q’S:
- Any history of systemic disorder?
- When and how did the lesion occur?
- Is it a complete or partial lesion? Was surgery performed?
- Is the client currently under the care of a neurologist? What prognosis was given?
- Is the physician or neurologist aware the client is coming for massage therapy?
- What functions have been most affected in ADL’s?
- Any sensory loss or sensory change?
- Does the client experience any pain?
- What type?
- Is client on any meds?
- Is client receiving any other treatment?
Erb’s Paralysis
CONTRAINDICATIONS:
Massage and movement of affected limb are CI’d for up to 3 weeks if surgical intervention occurred
Massage on site of lesion not advised until neurologist advises a trace contraction present
Do not traction or excessively move joints affected limb until muscle function has clearly returned
Hydro to limb should not begin until autonomic and vasomotor control have returned, indicated by return of muscle function and improved appearance of skin
Frictions and deep pressure on flaccid or compromised tissue is contraindicated
Joint play not performed until innervation occurs and joint stable
Rhythmic techniques avoided on body until some control of limb has returned
Klumpke (Dejerine-Klumpke) Paralysis
DEFINITION:
A traction or compression injury involving the lower brachial plexus (C8/T1 nerve roots)
Results in a combination median and ulnar nerve lesion
Klumpke (Dejerine-Klumpke) Paralysis
CAUSES:
In children, poor positioning at birth, breech or legs first or being pulled from birth canal by forceps
In adults, falling from a height and grabbing something to break the fall causes traction as the force of the person’s body weight stretches the C8 and T1 nerve roots
Klumpke (Dejerine-Klumpke) Paralysis
SYMPTOM PICTURE:
Similar to those of a median and an ulnar lesion a “claw hand” presentation combined with the thumb positioned on the same plane as the palm
Atrophy and functional losses primarily affect muscles of the forearm and hand, as well as triceps
Obvious changes in distal aspects of upper limb
Sensory losses affect C8 and T1 dermatomes, primarily on the ulnar side of the forearm and hand
Results in a functionless hand
Additional complication to Klumpke’s may be Horner’s Syndrome
Horner’s Syndrome manifests on the affected side with constriction of pupil (miosis), drooping of eyelid (ptosis), loss of sweating to face and neck (anhydrosis) and recession of eyeball into orbit (enophthalmos)
Klumpke (Dejerine-Klumpke) Paralysis
HEALTH HISTORY Q’S:
- Any history of systemic disorder?
- When and how did the lesion occur?
- Is it a complete or partial lesion? Was surgery performed?
- Is the client currently under the care of a neurologist? What prognosis was given?
- Is the physician or neurologist aware the client is coming for massage therapy?
- What functions have been most affected in ADL’s?
- Any sensory loss or sensory change?
- Does the client experience any pain? What type?
- Is client on any meds?
- Is client receiving any other treatment?
Klumpke (Dejerine-Klumpke) Paralysis
CONTRAINDICATIONS:
Massage and movement of affected limb are CI’d for up to 3 weeks if surgical intervention occurred
Massage on site of lesion not advised until neurologist advises a trace contraction present
Do not traction or excessively move joints affected limb until muscle function has clearly returned
Hydro to limb should not begin until autonomic and vasomotor control have returned, indicated by return of muscle function and improved appearance of skin
Frictions and deep pressure on flaccid or compromised tissue
Joint play not performed until innervation occurs and joint stable
Rhythmic techniques avoided on body until some control of limb has returned
Erb’s Palsy - Klumpke’s Palsy
Treatment:
Treatment:
Review ROODS Technique
