ERB′S PALSY BRACHIAL PLEXUS
Description of Condition
The human body is connected by a network of the nervous system. One of these nervous systems is the brachial plexus system where all arm nerves originate from. These nerves serve a crucial role in enhancing feeling and movement to the fingers, hand, arm, and the shoulder. Brachial plexus is associated with a number of complications. One of the complications is Erb’s Palsy. The condition is named after the first doctor who described it, Wilhelm Erb. Palsy refers to weakness. Thus, the whole term Erb’s Palsy Brachial Plexus refers to a condition of weakness in arm and loss of motion (BOORSTEIN, 2017). The condition is common to young children where one or two babies in every 1000 infants suffers from the condition. The condition is caused by overstretching of Infant’s neck during a difficult delivery.
For this assignment, I will present a case study of an infant diagnosed with Erb′s Palsy condition. This will include presenting patients’ medical history and prevailing concerns. A summary of current life roles, assessment and observation, proposed treatment of the condition, and discharge recommendation. Finally, the recommendation for therapy.
Patients Description
Pt hx Sx to move nerve from LUE
Underarm to brachial plexus @ 11
Min/0 mvnt of LUE prior to Sx
L clavicle Fx; R parietal, occipital cephalohematenia.
The patient is an infant of two months old. The patient has undergone surgery to move the nerve from the Left Upper Extremity (LUE). Prior to surgery, no or very minimal movement of brachial plexus. The patient also has a left clavicle fracture, which is extended to the right parietal, occipital cephalohematenia.
Summary of current functioning across life roles
Children with Erb′s Palsy function differently as compared to those with normal. In my case, the child has difficulty in grasping using his fist. As time goes, there is a slow rate in growth of his arm suffering from Erb′s Palsy. When lifting a hand, the affected hand hardly goes straight or goes higher beyond the head. Therefore, it is advisable for parents and caregivers to have close monitoring of their kids as they grow and give them moral support.
Available assessment and Observation
ROM, goniometer, AMS (brachial Plexus) ½ < GE <G=1/2
L- FROM WFL
R- PROM, AROM WFL
Description of Assessment
From the assessment and doctor’s observation of the patient, the range of motion (ROM) varies for the two shoulders. For the right shoulder, the patient is observed to have a passive range of motion (PROM) and within functional limits (WFL). On the right hand, he has a perceived range of motion (PROM) action range of motion (ARM) and within functional limits. After observing under active movement scale (AMS), Gravity and Gravity eliminated were determined. The angels were determined using a goniometer.
Proposed treatment plan
After diagnosis, observation and assessment indicated that the child had Erb’s palsy. Thus, I proposed for treatment of the condition to facilitate recovery and try to save the child’s hand. To ensure that the proposed treatment will achieve the general health of the child, goals, objectives, and suggested treatments were put into consideration.
Goals
To treat Erb′s Palsy, the overall goal is to improve the sensation and strength of the muscle, alleviate contractures of the joint and muscle that are found in the arm. In this case, the primary goals are;
- Increase the abduction of the shoulder to degrees above 90.
- Enhance the correct rotation of the internal arm.
- Increase the action range of motion, which improves the rate of extension and flexion in the elbow.
- To prevent deformities that might occur to the hand and the arm.
Objectives
- The objective is to see the proposed treatment successfully performed to improve the state of the patient.
- Another objective is to oversee the arm with the condition to recover and perform normal like the undamaged hand.
- Lastly, the other objective is to oversee the zero side effects of the treatment procedures performed to the patient.
Suggested treatment activities
The patient can benefit from a variety of available specialists. These specialists must be aware of how brachial plexus performs. For this case, neurosurgeons, physical therapists, and orthopedic surgeons can work best. Two treatment methods can be very successful in this case. Surgical and non-surgical treatments are the best fit for this condition.
- Surgical treatment
For serious Erb’s palsy condition, the patient may undergo surgery. For this kind of treatment, it’s advisable for children who are below six months as it is believed to be more effective, especially for an infant patient who requires microsurgery. In this case, this treatment procedure will be effective as the child is at two months (Nahas et al., 2018). To restore the normal functionality of the arm, grafting can be done, which has been proven to be very effective. Therefore, I suggest that the child be taken for surgery as it will be effective thanks to her young age.
- Non-surgical treatment
Alternatively, the patient can be offered massage and physical therapy. These two methods are associated with improving the strength of the nerves and arm. This treatment happens both at home and at the professional level (Nahas et al., 2018). The parent or the guardian is given sessions during clinic dates as the treatment method need to be performed frequently. However, if this method takes more time to give effects, surgery should be considered.
Discharge Recommendation
After treatment, whether surgical or non-surgical, it is essential to give the recommendation to facilitate recovery. This may include home programs, adaptations, and caregiver resources.
- Home programming
The child will not recover immediately after surgery. Therefore, caregivers and parents are given recommended to extend the following activities at home to facilitate recovery;
- Strength exercises.
- Try to improve movements within the range of motion.
- Constant gentle stretching.
- Routine gentle massage.
- Appropriate Adaptations after Discharge.
After surgery and discharge, the child (patient) is needed to learn to use certain adaptive tools to improve his daily functions. This can be enhanced through the use of therapies. These therapies will include teaching the child steps to dress independently (Nahas et al., 2018). Tools used include handles that ensure more participation of the affected arm. However, Occupational therapy is most effective. In this therapy, there is much stretching, activities, and orthotics.
- Community/Caregiver resources
Due to the rate at which Erb′s Palsy has been affecting most babies, it is essential for the caregivers and general community provided with resources to enlighten them about the condition. This will include giving the journals and medical articles to keep them updated.
For instance, the Journal of Orthopedic Surgery. From this, the community and caregivers will be aware of this Erb′s Palsy and be ready to deal with it.
References
BOORSTEIN, S. W. (2017). OBSTETRIC BRACHIAL PARALYSIS (ERB’S PALSY). JAMA: The Journal of the American Medical Association, 82(11), 862. https://doi.org/10.1001/jama.1924.02650370030010
Kong, L., & Lu, J. (2020, April 9). Journal of Orthopaedic Surgery and Research. Journal of Orthopaedic Surgery and Research. https://josr-online.biomedcentral.com/articles
Nahas, S., Yeoh, C., & Jahnich, H. (2018). Upper Brachial Plexus Palsy (Rucksack Palsy). Journal of Trauma & Treatment, 07(01). https://doi.org/10.4172/2167-1222.1000419
Appendix I
Pt- patient
Hx-history
Sx-surgery
LUE-left upper extremity
Min-minimum
0-none
Fx-fracture
R-right
ROM- the range of motion
AMS-active movement scale
GE-Gravity eliminated
G-gravity
PROM-passive range of movement
WFL- within functional limits
AROM- active range of motion