Obstetric Brachial Plexus Palsy

Question 1

pathology

Answer 1

injury to nerve roots of the brachial plexus

during delivery

Question 2

what is it?

Answer 2

2/1000
most common in large babies (macrosomia in diabetes)
twin deliveries
shoulder dystocia - difficult delivery of shoulder after the head - compression of shoulder on pubic symphysis

Question 3

what is the commonest palsy?

Answer 3

Erb’s palsy (C5&6)

Question 4

what is the pathology of Erb’s palsy?

Answer 4

injury to the upper nerve roots (C5&6) - loss of motor innervation of

• deltoid
• supraspinatus
• infraspinatus
• biceps
• brachialis

Question 5

how does Erb’s palsy present?

Answer 5

internal rotation of humerus - from unopposed subscapularis

Waiter’s tip posture

Question 6

how is Erb’s palsy managed?

Answer 6

physiotherapy - prevent contractures
prognosis predicted by the return of biceps function by 6 months
good outcome in 80-90%
surgical release of contractures and tendons may be required if there is no recovery

Question 7

what is Klumpke’s palsy (C8&T1)?

Answer 7

much rarer palsy

Question 8

what is the pathology at klumpke’s palsy?

Answer 8

injury to the lower nerve roots (C8&T1) by forceful adduction

• paralysis of the intrinsic hand muscles
• +/- paralysis of finger and wrist flexors
• possible horner’s syndrome - disruption of the first sympathetic ganglion from T1

Question 9

how does Klumpke’s palsy present?

Answer 9

fingers typically flexed - paralysis of the interossei and lubricals (extension at PIP)

Question 10

how is Klumpke’s palsy managed?

Answer 10

no specific treatment

poorer prognosis - 50% recovery