Clinical Experience: Baby with Erb's Palsy l

Guess who is back to his clinical posting?
Yes, yesterday was a thrilling moment for all of us in our final year. For a long time now, we have not been going to the teaching hospital where hands-on experience is obtained. But yesterday, the journey began again.

I spent my clinical hours in the electrotherapy unit throughout. For those who may not know, electrotherapy is a unit where we use electrical agents such as thermal or mechanical modalities to treat patients with muscle weakness, pain, atrophy, nerve injury, and so on.

Surprisingly, I saw that new modalities had already been brought into the unit while we were away from clinical posting. I didn’t take time to explore them yet since I was not fully settled back in the unit.

After our first lecture by one of the interns, we attended to a patient who came with her baby. The baby was presenting with Erb’s palsy, caused by breech position during birth. For the sake of those hearing about Erb’s palsy for the first time, let me explain this condition briefly.

Now, what is Erb’s palsy?

https://commons.m.wikimedia.org/wiki/File:Erb%27s_Palsy_1

Before defining it, let’s understand how nerves supply the upper limb. The nerve supply to the upper limb comes from a network of nerves called the brachial plexus. The word “plexus” simply means nerves connected together to form outlets that supply a part of the body. The muscles of the upper limb are controlled by the brachial plexus.

Below is a picture showing the brachial plexus.

https://commons.m.wikimedia.org/wiki/File:Brachial_Plexus_Logical_Schematic

Focus on the superior trunk of the brachial plexus because that is where our attention is. The superior trunk is formed by C5 and C6 from the root of the plexus. It then divides and gives off branches that supply some parts of the shoulder, arm, and forearm. When this superior trunk is injured or cut, there is either no supply or only partial supply to those parts of the upper limb. This is what we call Erb’s palsy. The baby we saw in the electrotherapy unit was presenting with this condition.

When the chief physiotherapist asked the mother what happened, she narrated that the baby was born in a breech position.

Breech position is when a baby comes out with the back or buttocks instead of the head. Normally, by the 34th week of pregnancy, the baby is expected to be in the correct position called the occipitoanterior position.

https://commons.m.wikimedia.org/wiki/File:Breech_presentation,_from_Ramsbotham,_Principals...1841_Wellcome_L0004298

Studies have shown that conditions such as multiple pregnancies, fibroid, and uterine abnormalities can predispose a baby to breech delivery.

Although I did not find out what exactly caused the breech in this baby’s case, what stood out was the presentation of the baby’s left hand. The baby clearly showed the “waiter’s tip” posture along with muscle weakness.
The waiter's tip shows the sign of Erb's palsy and the signs are internal rotation of the shoulder, extension of the elbow joint, pronation of the forearm, and flexion of the wrist.

What did we do for this baby?

The interns, under the supervision of the chief physiotherapist, recommended EMS, which we call Electrical Muscle Stimulator. This machine works by stimulating the weak muscles and activating the components that make them contract. It does not restore strength immediately but prepares the muscles gradually.

After the stimulation, we carried out passive stretching of the shoulder muscles to help reduce compression on the nerves that supply the upper limb. Massage was also applied to help relieve and relax the muscles around the shoulder region.

After that, the baby was handed back to the mother.

And that was it. Simple steps, yet the effect of the therapy was powerful. That is the physical effect of physiotherapy in action.

In conclusion, Erb’s palsy, though caused by birth complications like breech delivery, can be managed through early physiotherapy interventions. With proper stimulation, stretching, and consistent follow-up, affected babies have a better chance of regaining strength and function in the affected limb.

References

[1] Erb's Palsy | Symptoms, Causes, and Treatment for Children https://www.childbirthinjuries.com/erbs-palsy/
[2] Erb's Palsy: What Is it, Symptoms, Causes & Treatment https://my.clevelandclinic.org/health/diseases/21986-erbs-palsy
[3] Erb Palsy - StatPearls - NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK513260/
[4] Erb's Palsy | Birth Injury Center https://birthinjurycenter.org/erbs-palsy/
[5] Erb's Palsy (Brachial Plexus Birth Palsy) - OrthoInfo - AAOS https://orthoinfo.aaos.org/en/diseases--conditions/erbs-palsy-brachial-plexus-birth-palsy
[6] Erb's Palsy Overview | Symptoms, Causes, Treatment https://cerebralpalsyguidance.com/birth-injury/erbs-palsy/
[7] Erb's Palsy Causes, Diagnosis and Treatment - Baptist Health https://www.baptisthealth.com/care-services/conditions-treatments/erbs-palsy
[8] Erb's Palsy Symptoms | Early Signs & Treatment Options https://www.childbirthinjuries.com/erbs-palsy/symptoms/
[9] Neonatal Brachial Plexus Palsies Treatment & Management https://emedicine.medscape.com/article/317057-treatment
[10] Erb's Palsy Treatment | Best Treatment Options https://cerebralpalsyguidance.com/birth-injury/erbs-palsy/treatment/