Brachial Palsy

• prolonged, difficult labor ending in traumatic delivery
• most often in large babies prone to stretching injuries
• paralysis of upper arm more common than lower arm or whole arm
• if nerve roots not affected, infants regain neurologic function within several days, as hemorrhage and edema in area resolve

Erbs' palsy:

• an injury to the 5th and 6th cervical nerve roots due to abnormal traction force on the arm at delivery
• affected arm loses abduction, external rotation, and supination of the forearm
• upper arm paralysis: arm adducted and internally rotated, elbow extended, forearm pronated, wrist flexed (waiter's tip)
• The Moro, biceps, and radial reflexes are absent, while the grasp reflex is usually intact.
• X-rays to rule out clavicle fracture, which is the most common cause of decreased active motion of the upper extremity in a newborn.
• at 3 m/o, close exam reveals tightness of shoulder on internal rotation, difficulty supinating forearm and abducting shoulder

Klumpke’s paralysis:

• an injury to the 7th and 8th cervical and 1st thoracic nerve roots
• the intrinsic hand muscles are usually affected, the grasp reflex is absent, while the biceps, and radial reflexes are preserved. There may be associated phrenic nerve damage.
• X-rays to rule out clavicle fracture, which is the most common cause of decreased active motion of the upper extremity in a newborn.