ERB'S PALSY; PT Management

 ERB'S PALSY

Injury to the upper trunk originating from C5 and C6 nerve roots or injury to the C5 and C6 nerve root causes Erb- Duchenne palsy.

Causes

• Indirect injury

•  Vacuum delivery

•  Pressure on the supraclavicular area

•  During anesthesia

•  Injection of foreign vaccines and serum.

Signs and Symptoms

• Sensory

• There is loss of sensation in the area of deltoid insertion and lateral aspect of the forearm and hand.

Motor

• The muscles that will be totally paralyzed are the deltoid, biceps, brachia, brachialis, brachioradialis, supraspinatus, infraspinatus, teres minor, rhomboids and supinator. The muscles that will not be totally paralyzed but will be just weak are triceps, latissimus dorsi, serratus anterior, pectoralis major and extensor carpi radialis.

Reflexes

• Biceps and brachioradialis jerks are affected.

Deformity

• The patient will exhibit a deformity which is usually called as policeman’s tip or waiter’s tip. This deformity consists of extension,adduction, internal rotation at the shoulder, extension at the elbow, pronation and flexion at the wrist and fingers.

Functional Disability

• All the activities of daily living which involves flexion movement at the shoulder and the elbow will be lost. Thus the patient will have difficulty in eating, combing, washing, dressing, reaching out and other similar activities.

Treatment

The treatment comprises of:

•  IG stimulation to maintain the muscles property.

• Passive movement and stretching to prevent any joint contracture or deformity.

• Care of edema is very necessary as the hand is always in a dependent position with respect to gravity hence more chances of developing edema.

• Massage may be given to maintain the circulation and prevent any trophic changes.

• Splint that is given is aimed at maintaining the shoulder in the functional position. 

• Two splints commonly used are aeroplane splint and cheese splint. Both the splints prevent contracture of adductors and internal rotators. These splints also prevent any chances of shoulder dislocation. 

• It should be noted that the prognosis of Erb’s palsy is much better than the Klumpke’s palsy as the distal that needs to be covered by the axon to reach the end organ is very short.

• Strengthening exercises once recovery starts.