Brachial palsy in newborns

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Central nervous system

Brachial palsy is a paralysis or weakness of the arm caused by damage to the brachial plexus (the collection of nerves around the shoulder).

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

Brachial nerve injuries can occur during a difficult delivery. For example, it can occur if the infant's head and neck are pulled toward the side as the shoulders pass through the birth canal.

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

The infant may have varying degrees of arm paralysis:

• Brachial plexus injuries typically affect only the upper arm
• Erb's paralysis affects the upper arm and rotation of the lower arm
• Klumpke paralysis affects the hand (the infant may also have an eyelid droop on the opposite side)

Brachial palsy is less common now that delivery techniques have improved and there is more use of C-sections when needed (where the baby is removed surgically through the abdomen).

Risk factors include a larger than average newborn, shoulder dystocia, and breech delivery.

Arm and shoulder fractures can also affect newborns who have had a difficult delivery. Fractures can cause pseudoparalysis. The symptoms may be very similar, although the long-term outlook is very different.

Review Date: 09/25/2006
Reviewed By: Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor of Pediatrics, NYU School of Medicine, New York, NY. Review provided by VeriMed Healthcare Network.