View source for Disabled Village Children:Chapter 14: Erb’s Palsy: Arm Paralysis From Birth Injury

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{{SideSupplement|bookabbreviation=dvc|pagealt=is from pages 127 to 128 of|chapterpdf=http://hesperian.org/wp-content/uploads/pdf/en_dvc_2023/en_dvc_2023_14.pdf|bookurl=Disabled Village Children|booktitle=Disabled Village Children}}
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<li>[[Disabled Village Children:Chapter 14: Erb’s Palsy: Arm Paralysis From Birth Injury|Chapter 14: Erb’s Palsy: Arm Paralysis From Birth Injury]]</li>
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=== WHAT IS IT?===

Erb’s palsy is a paralysis of the muscles in a baby’s arm, caused by injury of the nerves in the shoulder at birth (during delivery). 
<table width=100% style="clear:both;">
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<td rowspan=2  style="width:30%;">[[Image:DVC_Ch14_Page_127-2.jpg|190px|left]]</td>
<td   style="width:50%;">The baby lies with one arm and hand twisted backward and does not move the arm as much as the other.</td>

<td rowspan=3 valign=top>[[Image:DVC_Ch14_Page_127-1.png|100px|right]]</td></tr>

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<td rowspan=2 style="padding-top:15px;">If the full range of motion of the arm is not kept through regular exercise, contractures will develop that may prevent lifting the arm above the shoulder or turning the hand palm up.</td>

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<td style=" line-height:110%;padding-right:30px;">''Severe Erb’s palsy in 14 year old boy. This is as high as he can lift his arm.''</td></tr></table>

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=== HOW COMMON IS IT? ===
Nerve injury causing Erb’s palsy occurs in approximately 1 out of every 400 births. It is much more common in babies who are born butt first (breech) because the shoulder is easily stretched and the nerves injured. 
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=== WHAT CAN BE DONE ABOUT IT? ===
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<td rowspan=2 style="width:50%;padding-right:30px;">With the baby, start range-of-motion exercises 2 times a&nbsp;day.</td>
<td style="width:20%;">[[Image:DVC_Ch14_Page_127-3.png|225px|center]]</td>
<td  style="width:30%;">[[Image:DVC_Ch14_Page_127-4.png|150px|center]]</td></tr>

<tr valign=top>
<td style{{=}}"line-height:110%;padding-left:30px; padding-right:30px;">''Extend the child’s arm and turn the hand upwards.''</td>
<td style{{=}}"line-height:110%;">''Then raise the arm straight over the child’s head.</td></tr>

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<td rowspan=2>When the child is old enough, have him do exercises himself, for range of motion and to increase strength.</td>
<td>[[Image:DVC_Ch14_Page_127-5.png|215px|center]]</td>
<td>[[Image:DVC_Ch14_Page_127-6.png|100px|center]]</td></tr>

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<td style{{=}}"line-height:110%;padding-left:30px; padding-right:30px;">''Ask him to lift his arm as high as he can, turning the palm up as far as he can,''</td>
<td style{{=}}"line-height:110%;">''and then lift it with the other hand as high as he can, with the palm up.''</td>
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</table>

{{note|If contractures have already formed, do exercises more often, for a longer time. Each time try to turn the hand up and lift the arm as high as possible. Hold it in the stretched position while you count to 25, or sing a song.}}
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====Other helpful exercises====
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<tr>
<td>
<div class{{=}}speechbub style{{=}}"position: relative;">
[[Image:DVC_Ch14_Page_128-1.png|200px|right|alt=child swings arm]]
<div style{{=}}"position: absolute; width: 75px; top: 100px; left: 0px;text-align:left; font-style:normal;">Swing arm in circle.</div></div></td>

<td>
<div  class{{=}}speechbub  style{{=}}"position: relative; ">
[[Image:DVC_Ch14_Page_128-2.png|165px|right|alt=child pulls arm up]]
<div style{{=}}"position: absolute; width: 75px; top: 40px; left: 160px;text-align:left; font-style:normal;">Pull hard.</div></div></td>
<td><div  class{{=}}speechbub  style{{=}}"position: relative;">
[[Image:DVC_Ch14_Page_128-3.png|165px|right|alt=child pulls arm to move shoulder]]
<div style{{=}}"position: absolute; width: 105px; top: 110px; left: 140px;text-align:left; font-style:normal;">Make circles with shoulder.</div></div></td></tr>
</table>

<table cellpadding="25">
<tr>
<td>
<div  class{{=}}speechbub style{{=}}"position: relative;">[[Image:DVC_Ch14_Page_128-4.png|270px|center|alt=child moves arm back and forth]]
<div style{{=}}"position: absolute; width: 150px; top: -20px; left: 140px;text-align:left; font-style:normal;">Move back and forth.</div></div></td>
<td>
<div  class{{=}}speechbub style{{=}}"position: relative;line-height:110%;">
[[Image:DVC_Ch14_Page_128-5.png|330px|center|alt=child pushes and pulls a stool]]
<div style{{=}}"position: absolute; width: 150px; top: -30px; left: 5px;text-align:left; font-style:normal;">Push and pull.</div></div></td></tr>
</table>


Look for ways to include these exercises in work and play.


<div class{{=}}speechbub style="position: relative; height: 400px; width:650px; line-height:110%;font-style:italic;">
[[Image:DVC_Ch14_Page_128-6.png|650px|left|alt=different exercises a child can do]]

<div style="position: absolute; width: 75px; top: 273px; left: 30px;text-align:left; ">Fly a kite.</div>
<div style="position: absolute; width: 75px; top: 275px; left: 115px;text-align:left; ">Sit back with weight on arms.</div>
<div style="position: absolute; width: 75px; top: 300px; left: 215px;text-align:left; ">Push hard!</div>
<div style="position: absolute; width: 92px; top: 298px; left: 340px;text-align:left; ">Buy your child a goat.</div>
<div style="position: absolute; width: 100px; top: 260px; left: 447px;text-align:left; ">Wash clothes. (Squeeze in 1 direction, and then the other.)
</div>
<div style="position: absolute; width: 100px; top: 270px; left: 560px;text-align:left; ">Grind maize.
</div>
<div style="position: absolute; width: 100px; top: 115px; left: 178px;text-align:left; ">Skip rope.
</div>
<div style="position: absolute; width: 100px; top: -10px; left: 260px;text-align:left;">Swing from trees (palms toward you).
</div>
<div style="position: absolute; width: 100px; top: 80px; left: 390px;">Hang clothes.
</div>
<div style="position: absolute; width: 100px; top: 10px; left: 505px;">Swing.</div></div>
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=====Prevention =====

Erb’s palsy can sometimes be prevented if the midwife or doctor takes care not to strain or force the baby’s shoulder when being born. Examination of the mother’s belly before birth should let the midwife know if the baby is likely to be born breech. In this case a hospital delivery by a skilled doctor or midwife may reduce the chance of injury.

Contractures and significant disability from Erb’s palsy can largely be prevented by exercises. Some weakness may last throughout life. 
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{{Previous and next sections|Chapter 13: Children Who Stay Small or Have Weak Bones|Chapter 15: Painful Joints}}
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[[en:Disabled_Village_Children:Chapter_14:_Erb’s_Palsy:_Arm_Paralysis_From_Birth_Injury]]