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Tuesday, February 8, 2011

ERB'S PLASY

The causes of Erb's palsy are:

1.Undue strectching of the head from the shoulder as in a manoeuvre to deliver the baby in breech presentation (birth injury).
2.In an adult it may follow a blow or fall on shoulder.


Muscles paralysed
  1. Supraspinatus
  2. Infraspinatus
  3. Subclavius
  4. Biceps
  5. Greater part of brachialis
  6. Coracobrachialis
  7. Deltoid
  8. Teres minor
Position of the Hand
Upper limb assumes the 'Waiter's tip' receiving position. The arm is adducted and internally rotated, the elbow is extended, forearm pronated. Movement of wrist and fingers are preserved.
In addition there will be loss of sensation down the lateral side of arm.

Treatment
Recovery depends largely on the severity of the lesion but is usually rapid though not always complete. In order to prevent contracture the upper limb should be maintained in abduction and lateral rotation. The forearm is semiflexed at elbow and supinated.

Aeroplane Splint
This is maintained by a modified abductor frame but in the first few weeks or months the limb can be maintained as above by fastening the arm to the mattress with straps. The splint is not easy to wear. especially since the wearer is usually a child.

Physiotherapy Management
1. Gentle passive stretching (affected segments)
2. Faradic stimulation.
3. Active movements as voluntary power begins to return
4. Surgery performed if contractures develop.



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