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Neuroanatomy
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
Which of the following statements regarding the brachial plexus are true and which are false? Spinal nerves C5-T1 give rise to the roots of the brachial plexus that lie anatomically between the scalenus medius and posterior neck muscles.The ventral roots of spinal nerves contain sensory axons that convey information such as proprioception, pain and temperature.In a patient presenting with weakness and wasting of the hand and sensory loss on the inner aspect of the forearm and hand, it is important to do a chest X-ray.Shoulder dystocia during birth is a common cause of Erb’s palsy.Spinal nerves C5-C7 usually give rise to the musculocutaneous nerve, which provides sensorimotor innervation to the upper arm, elbow and lateral aspects of the forearm.
Shoulder Dystocia
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Table 27.4 describes the most common palsies associated with shoulder dystocia. It is important to underscore that causation has never been proven between shoulder dystocia and palsies, and many palsies develop in babies delivered without shoulder dystocia. Erb palsy is by far the most common (>98%) and the one with the best prognosis (90% rate of full spontaneous recovery). For 65% of patients with Klumpke palsy, full spontaneous recovery can be expected, whereas in patients with a complete BPI, <50% will have this recovery. If sustained injury occurs, the evidence is mixed for the efficacy of surgery [62].
Shoulder Dystocia
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
In Erb’s palsy, the affected arm hangs down and is internally rotated and pronated. If the C7 nerve root is also involved, the wrist will be flexed and the fingers will be curled up. The appearance is classically known as the ‘porter’s tip position’ (Figure 10.2). Total BPI results in a paralysed arm with no sensation. There may be respiratory distress and feeding difficulties resulting from hemiparalysis of the diaphragm if the phrenic nerve is damaged, as well as contraction of the pupil and ptosis (i.e. Horner’s syndrome) if the sympathetic nerves are damaged. In Klumpke’s palsy, there is partial or total paralysis and loss of sensation in the forearm, wrist and hand.
Wilhelm Erb (1840–1921), an influential German founder of neurology in the nineteenth century
Published in Journal of the History of the Neurosciences, 2021
Electric stimulation over Erb’s point triggers the arm to take on a fencer position by eliciting the contraction of the muscles deltoideus, brachioradialis, biceps, and supinator longus. These muscles are paralyzed in the upper brachial-plexus paralysis of Duchenne and Erb (or Erb’s palsy) by a lesion of the C5 and C6 cervical nerve roots or of their uniting upper primary trunk of the brachial plexus. This distinct upper brachial plexus paralysis had been observed by Erb (1874b) in four patients with nearly pure motor deficits in the deltoid, biceps and brachial muscle, whereas only minor sensory disturbances were encountered in the thumb and index finger; in three posttraumatic cases, spontaneous recovery occurred; in the fourth, progression to spinal paraplegia and lethal outcome ensued due to a cancer.
The Relationship between Trunk Control and Upper Extremity Function in Children with Obstetric Brachial Plexus Palsy
Published in Developmental Neurorehabilitation, 2021
Gülay Çelik, Kıvanç Delioğlu, Tüzün Fırat
Trunk compensations developed by children with OBPP to increase arm movements on the impaired side may also support existing asymmetry, resulting in impaired trunk control. Although these compensatory strategies developed in OBPP seem to support the limb function in the short term, inappropriate loading caused by abnormal biomechanical forces leads to problems in the long term. Ismaeel et al.40 investigated the relationship between spine geometry and arm functions in 30 children aged between 3 and 6 years with Erb’s palsy. They found a significant relationship between impaired arm function and trunk imbalance and they showed that the trunk imbalance increased as the arm function decreased as parallel with our results. Ridgway et al.5 suggested that 31 of 32 children with OBPP had postural control problems including asymmetric posture and abnormal movement patterns and 56% of trunk asymmetry and 84% of weight transfer to the pelvis, trunk, and extremity in the impaired side decreased in their study group. Due to spinal and postural problems in OBPP, sitting balance and trunk control can be affected. Also, the size of the clinical problem may increase in proportion to the severity of the nerve injury.
Neonatal birth fractures: a retrospective tertiary maternity hospital review
Published in Journal of Obstetrics and Gynaecology, 2020
Andreas Rehm, Prakash Promod, Amanda Ogilvy-Stuart
We identified 66 neonates who sustained a fracture during delivery: 46 clavicle-, 13 humerus-, four skull-, one femoral-, one rib- and one tibial fracture. Five babies with fractures also had an Erb’s palsy; three with a humeral fracture (in 2 Erb’s palsy was on the side of the fracture, in 1, on the opposite side) and two patients with a clavicle fracture (both on the fracture side). All five made a full spontaneous recovery without the need for a referral to a specialist peripheral nerve injury unit. One neonate with a humeral fracture and one with a clavicle fracture also had shoulder dystocia. The patient who sustained a tibial fracture also presented with healed intrauterine fractures of other bones as a result of osteogenesis imperfecta type 3. The other neonates with a fracture had no known underlying metabolic disorders. The patient with the femoral fracture was delivered by emergency Caesarean section and the one with the tibial fracture by elective Caesarean section. Seven clavicle fractures were identified by the senior author which had not been reported by the reporting radiologists at the time of the imaging. The radiology department confirmed the senior author’s findings.