The development of medicine is ongoing. Every day, scientists invent new drugs, offer improved techniques for operations. Despite significant progress in this area, the problem of birth injury is still relevant. The greatest danger is not in the pathology itself, but its consequences. A striking example of a neurological disorder that a child may receive during delivery is damage to the brachial plexus. If there is a change in the structure of the cervical vertebrae, Duchenne-Erb paralysis is diagnosed. The main causes of pathology and treatment methods will be discussed below.
Brief description of the disease
A disease of the peripheral nervous system that develops as a result of damage to the brachial plexus is called Duchenne-Erb paralysis. Usually it is preceded by birth trauma. Therefore, pathology is often called obstetric paralysis. However, this is far from the only reason for this condition.
It is characterized by muscle weakness in the upper extremities, limitation of mobility in the shoulder and elbow joints. It is also possible a violation of sensitivity, but at the same time, the motility of the brushes persists. Duchenne-Erb obstetric paralysis cannot be overcome if a general therapy regimen is used. Treatment is always selected individually. After examination, one patient prescribes medication for some patients, and physiotherapy for others. In especially serious cases, surgical intervention is required. The prognosis for recovery depends on the severity of the pathology and the completeness of its treatment.
Historical background and some statistics
Duchenne-Erb paralysis got its name in honor of two neuropathologists. They were the first to describe in detail the etiology and clinic of the disease. The French doctor G. Duchenne for several years was studying the condition of small patients after a difficult birth. In 1872, he summarized the information received and presented a detailed description of the manifestation of paralysis in infants. In parallel, another doctor from Germany V. Erb was studying the disease. He managed to describe the anatomical picture of the development of the disease and the pathogenesis of this process in adults.
According to statistics, obstetric paralysis of Duchenne-Erb belongs to the category of rare pathologies. Currently, such a diagnosis is confirmed in every thousandth of a newborn. Despite the continuous improvement of obstetric techniques, the disease remains an urgent problem of modern medicine.
Causes of Paralysis in Newborns
Duchenne-Erb paralysis in newborns develops against the background of trauma to the brachial plexus. In the process of delivery, the obstetrician is forced to perform various actions to help the baby to be born. It should be noted that such measures are resorted to only in case of emergency. During such manipulations are possible:
- trauma to the scalene muscles ;
- sprain of the brachial plexus, ruptures of nerve bundles;
- minor bleeding in the affected area.
If the fetus is too large, and its parameters do not correspond to the size of the birth canal, the risk of damage to the shoulder joint increases several times. To help the baby to be born, obstetricians are forced to use special tools. With sudden movements, the brachial plexus of nerve fibers is torn.
Causes of Adult Paralysis
In older children and adults, the development of pathology is usually associated with trauma. These mechanical damages include:
- traction by the hand;
- neck injuries;
- bruise in the area of the brachial plexus;
- stretching.
Sometimes damage to the brachial plexus occurs due to a car accident. It is extremely rare for Erb-Duchenne paralysis in adults to occur due to toxic or infectious lesions. The development of the pathological process may be due to a tuberculosis infection occurring in a complicated form, typhoid and malaria.
What symptoms indicate an ailment?
With the development of so-called flaccid paralysis, loss of function of a number of muscles (biceps, deltoid, brachialis) is noted. The severity of symptoms depends on the nature of the damage to the fibers, impaired impulse conduction.
In most newborns, Duchenne-Erb paralysis is clearly manifested in the first days of life. The child becomes overly restless and cries constantly. The cause of the disorder is severe pain in the limb. The following symptoms may also indicate damage to the brachial plexus:
- arm constantly bent at the elbow;
- decreased muscle tone;
- weakened breathing;
- squeezing a hand into a cam with a thumb;
- pallor of the skin.
Despite the lack of activity of the sore arm, children are often observed movements of low intensity. However, if you place the newborn horizontally in the palm of your hand, the affected limb will hang slightly.
Stages of the pathological process
Duchenne-Erb paralysis develops in several stages.
The acute stage lasts from several hours to 2-3 days. At this time, there is a decrease in the activity of the hands, difficulty in the process of bending the arm at the elbow.
Then comes the recovery phase. With proper treatment, correction of lost functions can take several years. As a result, edema in the area of damage to nerve fibers disappears, and blood circulation is completely restored.
After this comes the stage of residual phenomena, which can last the rest of your life. Therefore, it is so important during the recovery period to actively engage in treatment. At the stage of residual phenomena, any therapeutic measures are most often ineffective. In the patient, the affected limb gradually hypertrophies, and with serious lesions it looks underdeveloped. The shoulder blade turns out on the sore side, its edge moves away from the spine. Over time, these changes lead to curvature of the spine - scoliotic deformation.
How is the diagnosis carried out?
Examples of studies of Duchenne-Erb paralysis still attract the attention of scientists from around the world. However, today the diagnosis of the pathological process does not cause any special difficulties. When the first signs appear, the pediatrician should send the newborn for a consultation with a neurologist and orthopedist. In adult patients, these specialists also treat the disease. To make a diagnosis, a neuropathologist must study the patient’s history and conduct a physical examination. Then proceed to a more detailed examination, which includes:
- electroneuromyography;
- MRI
- computer myelography;
- dinanometry;
- rheovasography;
- Ultrasound of the shoulder joint.
Usually, the external manifestations of the disease are sufficient to confirm the pathology. All information must be entered on the patient’s medical record. The doctor makes a mark, diagnoses “Erb-Duchenne paralysis”. ICD-10 has assigned this disease code P14.0.
However, to identify the nature of the damage, the above studies are required. Each of the diagnostic methods carries a specific task and cannot be replaced by another. Based on the test results obtained, the doctor can prescribe treatment and also give a prognosis for the future.
Drug therapy
Treatment for paralysis begins with conservative methods. In the acute period, it is not always possible to determine the degree of fiber damage due to severe tissue edema. Therefore, surgical procedures are considered inappropriate.
What medicines are used to combat such a pathology as upper Duchenne-Erb paralysis?
- Nonsteroidal anti-inflammatory drugs: Ibuprofen, Amidopyrine.
- Medicines to improve blood circulation: Pentoxifylline, Papaverine.
- Anticholinesterase medications that enhance the conduct of nerve impulses: "Neuromidine", "Galantamine", "Proserin".
- Preparations for the normalization of metabolism: Actovegin, Mexidol, vitamin complexes.
As the patient's condition improves, the dosage of drugs and the regimen are changed.
Physiotherapeutic procedures
The fight against the pathological process implies the so-called treatment of the situation. A tire is applied to the sore limb, which can only be removed during hygiene procedures.
To maintain muscle tone , the following measures are indicated:
- massage of the affected limb (start from the second week);
- muscle electrical stimulation ;
- therapeutic exercises with passive exercises;
- acupuncture;
- paraffin baths;
- ozokerite.
A positive effect of conservative therapy is possible only with partial damage to the fibers of the brachial plexus. He is waiting for about three months, after which they proceed to assess the results. If at this moment the patient does not appear active movements in the elbow joint, the question of surgery is resolved.
Surgical intervention
The essence of the operation is to restore the integrity of the damaged fibers. For this, nerve trunk plastic surgery is performed. This is currently the only operation that can help patients with a diagnosis of Duchenne-Erb paralysis. Treatment carried out in the first year of life of a small patient gives the best results. The operation itself does not remove the symptoms of the pathological process. It allows you to restore the path along which nerve impulses move. In the future, conservative treatment with the use of exercise therapy, massages is indicated.
Forecast for the future
You need to understand that the treatment of obstetric paralysis is a long and painstaking task that requires patience. All doctor's recommendations should be strictly observed in order to get a positive result. Many procedures last for months, especially for exercise therapy and massage.
How can Duchenne-Erb paralysis end: disability or recovery? Unfortunately, it is not possible to give an exact answer to this question. It all depends on factors such as:
- severity of damage;
- timeliness and adequacy of therapy;
- desire to follow all the doctor’s recommendations.
With partial damage to the brachial plexus, 100% recovery can be hoped for. At least, statistics say this. With a complete separation of chances, unfortunately, is much less.
Preventive measures
Can Duchenne-Erb paralysis be prevented? Photos of young children who had to deal with this disease really make you think about this issue.
In fact, the prevention of pathology is quite simple. It implies adequate management of pregnancy, the right choice of method of delivery. Even at the planning stage, you need to take care of your condition, try to eat right and not neglect sports. A healthy woman is more likely to have a baby without pathologies. In addition, the choice of a medical institution where the expectant mother decides to be monitored should be approached responsibly. It is necessary to read reviews about obstetricians, the very process of delivery in this clinic. You can also consult with friends who have already managed to try on the role of a mother. During the pregnancy itself, it is important to listen to the advice of a gynecologist, not to disregard his recommendations.