Brachial plexus palsy in neonates

Douglas J Lanska MD FAAN MS MSPH (Dr. Lanska of the Great Lakes VA Healthcare System and the University of Wisconsin School of Medicine and Public Health has no relevant financial relationships to disclose.)
Originally released June 2, 2003; last updated June 21, 2016; expires June 21, 2019

This article includes discussion of brachial plexus palsy in neonates, Duchenne-Erb palsy, Erb palsy, and Klumpke palsy. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Neonatal brachial plexus palsy can be a debilitating injury that leads to long-term disability in the infant. Although the majority of cases do recover full function of their arm, others must undergo surgery or other treatments to improve function. This article describes the pathology and anatomy of brachial plexus palsy, provides tips to examine an affected patient, and reviews the available treatment options.

Key points

 

• The most common brachial plexus palsy involves the upper roots, C5 and C6, and is called Erb palsy.

 

• The spontaneous recovery rate is 60%, and some children suffer permanent impairment.

 

• Surgical treatment is usually offered between 3 to 6 months of age for primary repair; otherwise, patients can undergo secondary procedures around 12 to 18 months of age.

 

• A multidisciplinary approach with the pediatrician, physical and occupational therapists, and the surgeon is very helpful when treating an infant with brachial plexus palsy.

Historical note and terminology

Neonates who have neurologic deficits have been observed since the time of the ancient Greeks and Hippocrates (Harpold et al 1998). Brachial plexus palsy related to the birth process, “obstetric brachial palsy,” was described by Scottish obstetrician William Smellie (1697–1763) in a textbook originally published in 1754 titled A sett of anatomical tables, with explanations, and an abridgment, of the practice of midwifery (Smellie 1754a; Smellie 1754b; Smellie 1764; Smellie 1793; McClintock 1877; Pollack et al 2000; Shelton 2010).

Image: William Smellie (1697–1763)

German neurologist and neurophysiologist Wilhelm Heinrich Erb (1840–1921) first compared neonatal brachial plexus palsy with that found in adults and concluded that it involved the upper roots (Watt et al 2007; Schmitt et al 2008).

Image: Wilhelm Heinrich Erb (1840–1921)

The term “Duchenne-Erb palsy” was coined because French neurologist Guillaume-Benjamin-Amand Duchenne (de Boulogne) (1806–1875) received credit for describing the brachial plexus palsy following delivery of affected newborns (Duchenne 1872; Brody and Wilkins 1969; Reincke and Nelson 1990; Jay 1998; Gilbert and Pivato 2005; Parent 2005; Rondot 2005; Schmitt et al 2008).

Image: Guillaume-Benjamin-Amand Duchenne (de Boulogne) (1806–1875)

In addition, brachial plexus injury to the lower roots (C8-T1) was first described by American-born French neurologist Augusta Klumpke (1859–1927) in 1885 (Klumpke 1999; Peltier 1999; Bogousslavsky 2005; Bogousslavsky 2011; Gilbert and Pivato 2005; Shoja and Tubbs 2007; Yildirim and Sarikcioglu 2008; Ellis 2010).

Image: Augusta Klumpke (1859–1927)

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