Obstetric Brachial Plexus Palsy Flashcards
what is obstetric brachial plexus palsy?
injury to the brachial plexus sustained during vaginal delivery
when does obstetric brachial plexus palsy commonly occur?
in large babies (macrosomia in diabetes) twin deliveries shoulder dystocia (difficult delivery of the shoulder after the head with compression of the shoulder on the pubic symphysis)
what is the most common type?
Erbs palsy
- injury to the upper (C5 and C6) nerve
which muscles does erbs palsy affect?
loss of motor innervation of the deltoid, supraspinatous, infraspinatous, biceps and brachialis muscles
what does erbs palsy cause?
internal rotation of the humerus (from unopposed subscapularis) and may lead to classic waiter’s tip posture
how is erbs palsy managed?
physiotherapy to prevent contractures early on
surgical release of contractures and tendon transfers may be required
how is the prognosis of erbs palsy determined?
predicted by the return of biceps function by 6 months
good outcome in 80-90% of cases
what is the waiter’s tip posture?
arm hangs down with hand turned out backwards
like a sly money deal
what is klumpke’s palsy?
rarer, lower brachial plexus palsy caused by damage to C8 and T1 nerve roots
what can cause klumpke’s palsy?
forceful adduction
what does klumpke’s palsy cause?
paralysis of intrinsic hand muscles +/- finger and wrist flexors
can possibly cause horner’s syndrome due to disruption of the first sympathetic ganglion from T1
how does klumpke’s palsy appear?
fingers are typically flexed due to paralysis of the interossei and lubricals which assist extension at the PIP
what is the prognosis like for klumpke’s palsy?
poorer than erb’s palsy with less than 50% recovery
how is klumpke’s palsy treated?
no treatment
which brachial plexus palsy carries the worst prognosis?
total brachial nerve palsy
