Erb's Palsy - Cerebral Palsy - Brachial Plexus: Information and resource for erb's palsy, cerebral palsy. What caused erb's palsy? What caused cerebral palsy? How did baby get brachial plexus? Questions answered, and lawyers and attorny's ready to hear what happened in your case to help determine if medical malpractice, doctor error or hospital mistakes caused erb's palsy, cerebral palsy, brachial plexus or other birth injury.

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Klumpke's Palsy

Klumpke's Palsy involves C7 and T-1 (cervical vertebra #7 and thoracic vertebra #1). There is weakness of the wrist and finger flexors and of the small muscles of the hand. It is extremely rare to have a true/isolated Klumpke's Palsy situation. The term is sometimes loosely applied when there is a total Brachial Plexus Palsy.

Treatment: There is no specific treatment. However, early immobilization is followed by passive movements with a view of preventing contractures (fibrosis of connective tissue and skin, fascia, muscle, or joint capsule that prevents normal mobility of the related tissue or joint). A regimen of physical therapy and/or occupational therapy may be prescribed. Surgery is an option in severe cases and especially if a nerve has been severed.

Risks: The bigger the baby, the higher the risks for Erb's Palsy type injuries. The doctor must assess some of the following information which may lead to potential higher probability for an Erb's Palsy or Brachial Plexus injury: Prior large birth weight babies; Gestational diabetes; Prior C-sections; Mother is very small physically, especially small pelvis; Small mother with large baby; Genetic or constitutional causes: Large women tend to give birth to large babies; Neural diabetics or pre-diabetes; Overdue pregnancies; Excessive maternal weight gain during pregnancy; Advance maternal age.

Pre-Delivery Prevention

To prevent: First, proper antenatal care, particularly for high-risk mothers (such as diabetic) is important. Second, antepartum assessment for fetal weight for macrosomic babies (large babies over 5,000 grams [definition varies per community, Acog, etc.]) Baby should be delivered Caesarean section.

Management for Shoulder Dystocia at delivery:

During delivery when a shoulder dystocia situation arises, the following methods are used in rapid succession when each in succession fails:
1) Rotation of the anterior shoulder: If unrotated by fingers, transvaginally to bring it in the anterio-posterior diameter.
2) Generous episiotomy and gentle downward traction with suprapubic pressure by an assistant obliquely to flex the anterior shoulder against the fetal chest.
3) McRoberts' Maneuver: A sharp flexion of the maternal thighs against her abdomen.
4) Woods Screw Maneuver: Dr. Woods in 1943 described this as the rotating of the fetus as a screw by inserting two fingers of the right hand and rotating anteriorly to dislodge the shoulder.
5) Extraction of the posterior arm inserting two fingers to grab the posterior arm when extracting same.
6) Zavanelli's Maneuver: Inserting two fingers and the hand to rotate the baby's head manually to the anterioposterior position whereby an immediate Caesarean section is performed.


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Copyright © 2000 Jason A. Waechter. All Rights Reserved. The content of this web site is provided for informational purposes only and is not intended to provide medical advice. For proper legal advice you should contact Jason A. Waechter. While we have made a careful effort to obtain information from reliable sources, we are not responsible for errors or omissions. Created by Netcorp, Inc.