Neural Observation
Douglas Weier
SDL Assignment
Area needing improvement: Brachial Plexus and Neural Innervation
Learning Objective: Know the risks factors for Brachial Plexus injuries. Be able to recognize Erb’s Palsy.
Mentor: Dr Gest
Stem: A 37 y/o G2P2 woman presents with her 3 day old girl. The mother is concerned that the child’s left arm still remains extended at her side. The mother was compliant with all prenatal care. The mother had the child at a natural birthing center with the help of an experienced midwife. After a difficult vaginal delivery, the child was responsive and able to feed. When the child’s head is lifted and dropped gently, her right arm moves outward, but her left remains extended and near her side.
Lead in: Which nerve is least …show more content…
Erb’s Palsy is a common nerve injury seen in vaginal births. Although there are numerous risk factors(increased birth weight, small birthing canal, breached position (1)), it sometimes can occur unexpectedly during difficult births. If the mother had risk factors such as pre-gestational diabetes or a child with a large birth weight, she would have been encouraged to undergo a C-section(1).
Erb’s palsy occurs when the brachial plexus is stretched during delivery leading to damage of the upper trunk(from C5 and C6 roots). It is most commonly seen due to shoulder dystocia where the shoulder is stuck after the delivery of the head. It can therefore affect all nerves containing the C5 and C6 roots. The most common presentation is an extended arm that is medially rotated and adducted.
Klumke’s is another brachial plexus lesions which can occur when the arm is pulled overhead during a rough delivery. It would present with C8/T1 signs such as an ulnar claw hand. However the patient does not present with ulnar signs. (1)
Medially rotated: Damage to the suprascapular nerve[Answer A] (C5) leads to defect of the infraspinatus. The infraspinatus laterally rotates the arm. Deficit in the infraspinatus leaves the arm medially
SDL Assignment
Area needing improvement: Brachial Plexus and Neural Innervation
Learning Objective: Know the risks factors for Brachial Plexus injuries. Be able to recognize Erb’s Palsy.
Mentor: Dr Gest
Stem: A 37 y/o G2P2 woman presents with her 3 day old girl. The mother is concerned that the child’s left arm still remains extended at her side. The mother was compliant with all prenatal care. The mother had the child at a natural birthing center with the help of an experienced midwife. After a difficult vaginal delivery, the child was responsive and able to feed. When the child’s head is lifted and dropped gently, her right arm moves outward, but her left remains extended and near her side.
Lead in: Which nerve is least …show more content…
Erb’s Palsy is a common nerve injury seen in vaginal births. Although there are numerous risk factors(increased birth weight, small birthing canal, breached position (1)), it sometimes can occur unexpectedly during difficult births. If the mother had risk factors such as pre-gestational diabetes or a child with a large birth weight, she would have been encouraged to undergo a C-section(1).
Erb’s palsy occurs when the brachial plexus is stretched during delivery leading to damage of the upper trunk(from C5 and C6 roots). It is most commonly seen due to shoulder dystocia where the shoulder is stuck after the delivery of the head. It can therefore affect all nerves containing the C5 and C6 roots. The most common presentation is an extended arm that is medially rotated and adducted.
Klumke’s is another brachial plexus lesions which can occur when the arm is pulled overhead during a rough delivery. It would present with C8/T1 signs such as an ulnar claw hand. However the patient does not present with ulnar signs. (1)
Medially rotated: Damage to the suprascapular nerve[Answer A] (C5) leads to defect of the infraspinatus. The infraspinatus laterally rotates the arm. Deficit in the infraspinatus leaves the arm medially