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Some Medical Professionals Ill-Informed About Erb's Palsy

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Cincinnati, OHErb's Palsy affects three out of every 2,000 live births in the US. According to medical writer Carrie Schmitt Harrison, the condition, which is typified by paralysis of the arm and stems from nerve damage, is more common than Down syndrome and muscular dystrophy. Yet there is a great deal of incorrect information out there.

Even some medical caregivers are unfamiliar with the symptoms and treatment options for Erb's Palsy, also known as shoulder dystocia. The reality is that the condition can be effectively treated, but early intervention is key. Experts at the Cincinnati Children's Brachial Plexus Center (CCBPC) agree that the greatest challenge in treating the condition is identification and diagnosis. All too often this doesn't happen because of the prevailing lack of awareness about the condition.

Erb's Palsy stems from an injury to the brachial plexus, a network of nerves in the neck area controlling movement and sensation in the shoulder, wrist, elbow, hand and fingers. Injuries range from mildly stretched nerves to nerves that are completely torn from the spinal cord.

A difficult birth often serves as the genesis of Erb's Palsy. Not all injuries to the brachial plexus are birth-related, but newborns are at the greatest risk for nerve damage, usually when their shoulders become wedged in the birth canal. The use of forceps and other tools during a difficult birth can also lead to nerve damage.

It should be noted that while newborns are at greatest risk, a slight majority of Erb's Palsy patients—54 percent—develop the condition in the absence of a known or identified cause.

A recent case being heard in Middlesex Superior Court noted that a child affected by Erb's Palsy was a large baby—a fact that in itself puts babies at risk for shoulder dystocia if born through natural childbirth. The defendants in the case moved to preclude the testimony of an expert witness. In his testimony, the expert witness opined that should other known causes of Erb's Palsy be ruled out, then in his opinion the injury to the brachial plexus was likely the result of excessive traction.

The expert witness was found by the court to have satisfied the Daubert admissibility standard, and the motion on the part of the defendants to preclude the expert testimony was denied.

Once Erb's Palsy has been diagnosed, treatment protocols are fairly rigid and timelines are important. "This injury should be identified early enough that these children are able to receive the treatment they need," said orthopedic surgeon Mohab Foad MD, in comments to be published in the November issue of Pediatrics for Parents. "My preference is to proceed with nerve reconstruction as soon as it becomes clear that it is needed. The optimal time for surgery is before nine months, although it is still an option after 9-12 months."

He went on to say that while there is still opportunity for treatment beyond the optimal window, "repairing the nerves is no longer an option."

The problem then is the lack of understanding about Erb's Palsy, together with the lack of knowledge about treatment options. Linda Michaud MD, co-director of the CCBPC, notes that too many healthcare professionals remain misinformed.

"Before our families find our center with brachial plexus specialists, many are told that their children will heal on their own or that nothing can be done for them," she told Harrison.


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