Erb-Duchenne Palsy

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1- Introduction

2- Anatomical Overview

3- Treatment 

Introduction

Upper lesions of the brachial plexus are injuries resulting from excessive displacement of the head to the opposite side and depression of the shoulder on the same side. This causes excessive traction or even tearing of C5 and 6 roots of the plexus.
© image from snell's clinical anatomy
© image from moore clinically oriented anatomy

Anatomical Overview

The brachial plexus is an organized intermingling of the nerve fibers of the five adjacent anterior rami (C5–T1, the roots of the plexus) innervating the upper limb. Formation of the brachial plexus initially involves merging of the superior and inferior pairs of roots, resulting in three trunks that each divide into anterior and posterior divisions.

Anatomy Involved

  • Brachial Plexus:

    • Upper Trunk: Formed by the union of the C5 and C6 nerve roots.
    • Nerves Affected:
      • Suprascapular Nerve: Innervates the supraspinatus and infraspinatus muscles.
      • Musculocutaneous Nerve: Innervates the biceps brachii, brachialis, and coracobrachialis muscles.
      • Axillary Nerve: Innervates the deltoid and teres minor muscles.

  • Muscles Affected:

    • Deltoid: Abducts the arm.
    • Biceps Brachii: Flexes the elbow and supinates the forearm.
    • Brachialis: Flexes the elbow.
    • Brachioradialis: Assists in elbow flexion.
    • Supraspinatus: Initiates abduction of the arm.
    • Infraspinatus: Externally rotates the arm.
    • Teres Minor: Externally rotates the arm.
© image from color atlas of anatomy

Treatment

  • Non-Surgical Treatment

    1. Occupational Therapy:

      • Functional Skills: Techniques to improve daily living skills and adapt to any limitations.
      • Splinting: Use of splints to maintain proper joint position and prevent deformities.

    2. Electrical Stimulation:

      • Muscle Stimulation: Low-level electrical stimulation to encourage muscle contraction and strength development.

    Surgical Treatment

    1. Indications for Surgery:

      • Lack of improvement or inadequate recovery after 3-6 months of conservative treatment.
      • Severe cases with complete nerve rupture or avulsion.

    2. Surgical Options:

      • Nerve Grafting: Transplanting a healthy nerve to replace the damaged nerve segment.
      • Neurolysis: Removing scar tissue that may be compressing the nerve.
      • Tendon Transfers: Re-routing tendons from functioning muscles to improve movement in the affected arm.
      • Muscle Transfers: Transferring muscles from other parts of the body to restore function in the arm.
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