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Erb' Palsy

  1. Mode of Injury
    1. Excessive downward stretching of shoulder on same side & head towards opposite side eg.
    2. Blow or Fall on shoulder
    3. Delivery
  2. Site of Injury
     
    Upper C5 & C6 roots of brachial plexus (Erb's point) where 6 nerves meet
  1. Paralyzed Nerves & Muscles
    1. Musculocutaneous N.
      1. Biceps brachi ms.
      2. Brachialisms.
      3. Coracobrachialis ms.
    2. Axillary N.
      1. Deltoid ms.
      2. Teres minor ms.
    3. Nerve to Subclavius
      1. Subclavius ms.
    4. Supra Scapular N.
      1. Supraspinatus ms.
      2. Infraspinatus ms.
  2. Deformity & Loss of Movements
    1. Policeman/Waiter /Porter’s tip hand
      1. Arm: Adducted & Medially rotated
      2. Forearm: Extended & Pronated
      3. Arm hangs limply by the side
    2. Lost movements -
       
      (Mnemonic: FAbErS is lost)
      1. Flexion at elbow
      2. Abduction at shoulder
      3. External rotation at shoulder
      4. Supination of forearm
i.e. All movements opposite to the deformity would be lost
 

 

Extra Edge
Klumpke’s paralysis occurs due to injury to lower trunk (mainly T1 & partly C8) of brachial plexus leading to, horner’s syndrome, claw hand & cutaneous anesthesia in narrow zone along ulnar nerve.

  1. Abduction of Shoulder
    1. Upto 15° 
      1. Supraspinatus muscle
      2. Nerve — Suprascapular N (C5 C6)
    2. 15° — 90°
      1. Deltoid muscle
      2. Nerve — Axillary nerve (C5 C6)
    3. Overhead abduction (>900) 
      1. Serratus anterior muscle (Nerve supply- Long thoracic nerve or N. of Bells )(C5 C6 C7)
      2. Trapezius muscle (N.S.- Spinal part of accessory nerve)




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