Erba's paralysis: causes, symptoms, diagnosis, treatment

Erba's paralysis is named after the German scientist Erba (W. Erb). In 1874, he proved that as a result of obstetric manipulation during the birth shoulder muscles, which are innervated from the 5th and 6th cervical segments of the spinal cord, are affected. As a result, the upper paralysis develops.

ICD-10 code

P14.0 Erb's birth palsy.

What causes Erba's birth palsy?

Erb's paralysis is considered to be the most common birth trauma of the brachial plexus (diagnosed in 1-2 newborns out of 1000).

The nature of the presentation of the fetus, a large mass (more than 4000 g), difficult, protracted labor with the use of benefits (turn on the leg, the imposition of obstetric forceps, etc.) should alert the pediatrician. In this case, the function of the axillary nerve that extends from the posterior bundle of the brachial plexus and innervates the posterior portion of the deltoid muscle, the three-headed and brachial muscles, the extensors of the hand and the common extensor of the fingers suffer more often. Also, the function of the suprascapular nerve, innervating the supraspinous muscle, suffers.

Symptoms of ancestral paralysis of Erb

They distinguish the period of acute paralysis, the recovery period and the period of residual phenomena.

• The period of acute paralysis proceeds from several hours to several days after birth. When paresis, decrease the active movements of the upper limb: bending at the elbow joint, lifting the shoulder, reducing the activity of the fingers. In case of paralysis, the arm is located along the trunk, unbent at the elbow joint; active movements are absent in all segments of the affected limb.
• The recovery period lasts up to 2-3 years. At this stage, there is a resolution of edema, normalization of blood circulation in damaged tissues, restoration of active muscle function under the influence of therapeutic measures.
• The recovery period gradually passes into the period of residual paralysis phenomena, when the repair processes in the damaged nervous tissue terminate. Developing the resulting contracture of the shoulder, its internal rotation and subluxation to the back. The hypotrophy of the shoulder joint area is expressed. The scapula is rotated and its vertebral margin protrudes posteriorly. In the elbow joint the flexural contracture is formed, the rotational movements of the forearm are violated. The brush is in the position of the palmar or dorsal flexion, the function of the extensors of the fingers and the hand suffers.

Treatment of ancestral paralysis of Erb

A pediatrician, a neurologist and an orthopedist should conduct a conservative treatment of the genital paralysis of Erba from the first days of the child's life. One of the first tasks is to prevent the development of contractures. Using a cotton-gauze wedge-shaped tire, the affected limb is placed in the following position: the shoulder is rotated outwards to the middle position and retracted by 90 °. The forearm is given the position of supination at 30 ° with flexion in the elbow joint to 90 °: the brush in the rear inflexion does not exceed 20 °. After 3 weeks begin massage, therapeutic gymnastics, physiotherapy. Prescribe as a drug treatment aimed at normalizing the functions of the central nervous system, the restoration of neuromuscular conduction.

Early complex conservative treatment of Erb's paralysis leads to a positive effect in 70% of patients. In the absence of positive dynamics from ongoing therapy, a neurosurgeon should be consulted to resolve the issue of neurosurgical recovery.

In the period of residual events, when the paralytic condition stabilizes, and stable contractures and muscular atrophies have already formed, resort to reconstructive-plastic interventions. These measures are carried out with the goal of creating a functionally advantageous position of the limb and, if possible, restoring its active functions.