Brachial palsy in the neonate

Alternative names:

Erb's palsy; Erb-Duchenne paralysis; Klumpke paralysis

Definition:

Paralysis of the arm of varying degree caused by damage to the brachial plexus (the collection of nerves near the shoulder), the fifth and sixth cervical nerves (Erb's), and the seventh and eighth cervical nerves (Klumpke).

Causes, incidence, and risk factors:

Neonatal brachial nerve injuries are produced during a difficult delivery when the infant's head and neck can be pulled toward the side while trying to deliver the shoulders.

The condition can also be caused by excessive traction on the shoulders during a vertex delivery (head first) or on the raised arms during a breech delivery (feet first).

The infant may have varying degrees of arm paralysis:

• brachial plexus injury typically affecting only the upper arm
• Erb's paralysis affecting the upper arm and rotation of the lower arm
• Klumpke paralysis affecting the hand (the infant may also have a lid droop on the opposite side)

The incidence of brachial palsy has decreased with improved delivery techniques and the judicious use of C-section. Risk factors include a larger than average newborn (LGA), shoulder dystocia, and breech delivery.