Erb's Palsy Research Articles

Maintenance, training and functional use of denervated muscles

In the case of cerebral paralyses electrical stimulation can not only maintain the muscles, but may also enable their functional use. In flaccid paralyses, however, the conventional therapy using exponential currents produces rather unsatisfactory results. Only when applying bi-directional currents, were we successful in producing tetanic contractions. At present, some 20 children suffering from different diseases, such as spina bifida, Erb's palsy or a tumour of the cord, perform a daily domiciliary treatment with especially constructed home stimulators. measurements prove distinct improvements of blood circulation, phosphoric metabolism and of the condition of the affected extremities. First investigations with computer-controlled, multi-channel devices show that by means of these devices the efficiency of training can be improved, the daily time for treatment can be shortened, and the disabled patient can perform the training almost autonomously. The existing experience on simple locomotion chains, and the achieved strengthening of the muscles will gradually enable a functional electrical stimulation of flaccid, denerved muscles and thus extent the radius of action for the disabled patient, for example by gripping, standing upright or walking.

Some family problems associated with the presence of a child with handicap in Nigeria.

The problems presented in 53 families by the presence of handicapped children arising from cerebral palsy, poliomyelitis, Erb's palsy, talipes, arthrogryposis multiplex congenita and trauma, were studied in Benin City, Nigeria. Among other things, most fathers were found to be indifferent to their handicapped children and there was a highly significant difference in attitude between educated and enlightened fathers of handicapped children, and their barely educated counterparts. A statistically significant proportion of handicapped children were prevented from going to school because of their disabilities and in half of the families studied, occasional squabbles arose because of the presence of a handicapped child. It is suggested that Nigeria and similar developing countries should lay emphasis on health education in their on-going primary health care schemes.

Management of Term Breech Presentation in Primigravidae

In a prospective study of 231 breech presentations in primigravidae at term 260 (81 per cent) were delivered vaginally with no perinatal mortality. A single case of fetal injury (Erb's palsy) was recorded and only one infant had an Apgar score of under 7 at 5 minutes. In 17 patients selected for vaginal delivery, caesarean section was necessary for abnormal uterine activity, prolapse of the umbilical cord of fetal distress. Elective caesarean section wad performed if routine x-ray pelvimetry showed values below defined limits at the brim, midcavity, or outlet or if the fetal head was extended.

Management of term breech presentation in primigravidae.

In a prospective study of 231 breech presentations in primigravidae at term 260 (81 per cent) were delivered vaginally with no perinatal mortality. A single case of fetal injury (Erb's palsy) was recorded and only one infant had an Apgar score of under 7 at 5 minutes. In 17 patients selected for vaginal delivery, caesarean section was necessary for abnormal uterine activity, prolapse of the umbilical cord of fetal distress. Elective caesarean section wad performed if routine x-ray pelvimetry showed values below defined limits at the brim, midcavity, or outlet or if the fetal head was extended.

1314 EFFECT OF ARM POSITION ON HYPOVENTILATION DUE TO DIAPHRAGMATIC PARALYSIS

We report a 3970 gm term infant who sustained bilateral Erb's palsies, left facial palsy, and right hemidiaphragm paralysis because of a difficult delivery. Cyanosis, tachypnea and shallow respirations persisted, requiring mechanical ventilation and oxygen supplementation. We hypothesized that placing the arms above the head would expand the chest, allow more efficient use of intercostal and accessory muscles, and improve ventilation. This was tested by measuring arterial blood gases when the arms were extended down at the sides and when the arms were up beside the head: Summary and conclusions: Ventilation is markedly improved by positioning the arms above the head. This has relevance in management of hypoventilation due to neuromuscular problems, flail chest from rib fractures, severe rickets, and chest deformities.

The universal muscular chain reaction, muscle spasm, Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.

Infantile Cortical Hyperostosis with Unusual Clinical Manifestations

Infantile cortical hyperostosis may mimic a variety of serious conditions in early infancy, such as trauma, vitamin deficiencies, infection, or tumors, In a patient in good general condition there are typical roentgenological features often with involvement of the mandible that are diagnostic of the condition. In 3 cases of infantile cortical hyperostosis (Caffey's disease), one had the clinical picture of Erb's palsy and subsequently developed hyperostosis of the scapula. The second, had a "pulled elbow" and radial nerve palsy and later developed hyperostotic changes in the humerus and radius on the same side. The third was referred for treatment of congenital torticollis and found to develop hyperostosis of the clavicle on the same side. The recognition of this condition obviates unnecessary prolonged investigation and treatment.

Anterior Subglenoid Dislocation of the Shoulder in an Infant Following Pneumococcal Meningitis

A 7 1/2-month-old boy had an anterior inferior dislocation of the shoulder. Dislocations of the shoulder in infants have previously been reported, and were either congenital dislocations with associated anomalies of the glenohumeral joint with dislocations from Erb's palsy or septic arthritis. In the present case, dislocation of the shoulder was associated with spastic brain damage. The marked spasticity of the deltoid muscle may have been the deforming force. Capsular and subscapularis plication plus recession of the deltoid corrected the deformity and prevented further dislocations.

Monoparesis. Complication of constant positive airways pressure.

Erb's palsy has been observed in 2 infants who had been treated with constant positive airways pressure for idiopathic respiratory distress syndrome. Both infants made complete neurological recovery from what was thought to be an acquired injury from the neck seal.

Acquired eventration of the diaphragm in the newborn

Twelve neonates with traumatic paralysis of the phrenic nerve and diaphragmatic eventration are described. There were a number of associated lesions, especially Erb's palsy, which occurred in 11 cases. Eight children with paradoxical respiration and marked shift of the mediastinum were treated by operative plication of the diaphragm; all recovered and are well 2–11 yr after operation. Four children with less severe lesions were treated conservatively. Three are well but one died unexpectedly some weeks later of bronchopneumonia and atelectasis.

Infantile cortical hyperostosis of the scapula presenting as an ipsilateral Erb's palsy

Proctor, N. S. F. : Placental bilharzlasls. Report of a case, S. Afr. J. Obstet. Gynecol. 3: 76, 1965. 3. Schacher, J. F., and Hajj, S. N.: Taenla proglottid in the human uterus, Am. J. Trop. Med. Hyg. 19. 626, 1970. 4. Symmers, W. St. C.: PathoIogy of oxyurlasls with special reference to the presence of oxyuris vermicularis and its ova in the tissue, Arch. Pathol. 50: 475, 1950. 5. Ochsner, A., Debakey, E., and Dixon, L.: Complication of ascariasis requiring surgical treatment, Am. J, Dis. Child. 77: 389, 1949. 6. Phuae, V. It. H., and Schmauss, A. K.: Emboll elnes ausgewachsenen Ascaris lumbricoides in die Arterie Femoralls, Aus der Chirug. Univ-Klinik im Krankenhaus der Vietnamesisch-Deutschen Freudschaft in Hanoi, NMW 31, 1965. 7. Faust, E. C., Russel, P. F., and Jung, R. C.: Ascariasls. Clinical parsitology, ed. 8, Philadelphia, 1970, Lea & Febiger, Publishers, p. 338. 8. Phan, T.: Eclosion larvaire intracorporelle des oeufs d'ascaris erratiques chez un garcon de 4 arts, Pathol. Microbiol. 28: 443, 1965.

Malfunction of the intact diaphragm in infants and children.

The present study reviews the experience with six infants and young children who had malfunction of the diaphragm and were treated at the UCLA Hospital during the past ten years. Three had true eventration with aplasia or atrophy of the muscle fibers. Two sustained phrenic nerve injury at birth, resulting in phrenic paralysis. One infant had the unusual malformation of phrenic nerve agenesis, associated with phocomelia and agenesis of the left lower lobe of the lung. Phrenic plication produced immediate relief of respiratory distress in five of the infants, each of whom is alive from six months to eight years postoperatively. The condition of one with phrenic nerve and Erb's palsy improved without operation.

Problems and Immediate Outcome of Infants of Diabetic Mothers

Objective: The present study was undertaken to evaluate the problems and immediate outcome of infants of diabetic mothers (IDMs) in early neonatal period and to compare the results between infants of gestational and pregestational diabetic mothers. Design: A hospital based prospective study. Setting: The study was done in Chittagong Medical College Hospital, a tertiary hospital in Chittagong city. Method: Within one hour of delivery 52 infants of diabetic [pregastational & gestational] mothers consecutively admitted were enrolled in the study. Study period was January 2002 to August 2002. Results: Total number of IDMs were 52. Among them 31 were gestational and 21 were of pregestational diabetic mothers. Significant number 82.6% of IDMs were delivered by caesarean section. The mean birth weight of IDMs was significantly high (3212±563g), 21% of IDMs had birth weight>4000 g. Total 23% of the IDMs developed perinatal asphyxia. The 23% of IDMs developed hypoglycaemia. The incidence of hypoglycaemia was higher in infants of pregestational diabetic mothers as compared to that of gestational diabetic mothers (38.09% and 12.9% respectively), the difference was statistically significant (P<0.05).In majority (66%) of IDMs cases hypoglycaemia was symptomatic. Significant number (19.2%) of IDMs had hypocalcaemia. The incidence of polycythaemia was higher in infants of gestatational diabetic mothers(GDMs) as compared to infants of pregestational diabetic mothers (25.8% and 9.5% respectively), difference was statistically significant (P<0.001). 3(5.7%) out of 52 IDMs had congenital malformation (each one in number polydactyly, cleft palate & preauricular skin tag). Total death was 3 (5.7%) all of them died within 72 hours of birth. Causes of death 1 each number: perinatal asphyxia, respiratory distress syndrome and meconium aspiration syndrome. 11 IDM was macrosomic, among them 1 had birth injury ( Erb's palsy), hypoglycaemia and meconium aspiration syndrome and expired within first 24 hours of life. Conclusion: Among the important problems the present study revealed perinatal asphyxia, hypoglycaemia, hypocalcaemia, polycythaemia top the list. These babies should be delivered at hospitals where special neonatal care available for management of high risks babies to reduce the morbidity and mortality. Screening for GDMs should be performed in all pregnant women. All diabetic women should have planned pregnancy and proper antenatal care in order to maintain strict glycaemic control, to have a satisfactory outcome in infants of diabetic mothers. DOI: 10.3329/jbcps.v26i2.4183 J Bangladesh Coll Phys Surg 2008; 26: 62-72

The Military Brace Syndrome

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Roentgen Findings in Obstetrical Injuries to the Brachial Plexus

Injury to the brachial plexus with resulting paralysis occurring at birth is caused by stretching of the nerves when the head and shoulder of the infant are forcibly separated (5). This may occur in vertex presentations when traction and lateral flexion are exerted on the neck while the shoulder is fixed in the maternal pelvis. In breech presentations, forceful manipulation with abduction and elevation of an arm and shoulder may exert excessive traction against a fixed neck. Other possible causes are difficult labor, forceps delivery, marked relaxation of the muscles of the fetus from profound anesthesia, and the use of undue force. In mild cases, there may be only hemorrhage or edema of the nerve sheaths, and spontaneous recovery usually occurs within three to six months. In more severe cases, there may be nerve-sheath rupture, hemorrhage into the nerve trunks, separation of nerve fibers, or partial or complete division of nerve trunks. Avulsion of the nerve roots from the spinal cord may also occur. The condition is not attributable to rupture of the capsule of the shoulder joint or to separation of the epiphysis of the humeral head (5). The paralysis has been classified into upper-arm, lower-arm, and whole-arm types. In the upper-arm type, or Erb's paralysis, the fifth and sixth cervical roots are involved. The arm hangs at the side with the extremity internally rotated and the forearm pronated. The elbow and wrist are flexed. The attitude of the extremity has been referred to as the “waiter's tip” position. When the paralysis persists, the limb becomes atrophic, contractures result, and external rotation is impaired. In the uncommon lower-arm type, or Klumpke's paralysis, the seventh and eighth cervical and first thoracic roots are involved. Loss of function of the intrinsic hand muscles, the flexors of the wrist, and the long flexors of the fingers results in a clawhand. Horner's syndrome may be associated with this paralysis as a result of injury to the cervical sympathetic fibers which enter the cord through the first dorsal root and, in some instances, the eighth cervical root. In the whole-arm type, roots C5 through T1 are involved. The entire arm is flaccid with wrist drop and paralysis of the small muscles of the hand. Marked atrophy of the arm is present, and its growth is delayed. Roentgen Findings In the injured newborn, the metaphysis of the humerus is farther from the glenoid than normal (Fig. 1). Development of the epiphyses of the humeral head is retarded (Fig. 2), and atrophy of the soft tissues around the shoulder joint is present (Fig. 3). The scapula is elevated and rotated outward. Later, the ossification center for the humeral head may lie lateral to that of the greater tuberosity because of internal rotation of the humerus. If the phrenic nerve is involved, the diaphragm on the affected side is elevated (Fig. 4) (2).

Motor patterning following transitory sensory-motor deprivations.

Introduction NUMEROUS AUTHORS have recently emphasized the importance of early learning and experience, which seem to be of a different kind than that which occurs later in life. They also have insisted on the possibility of an age limit in acquiring certain skills, perceptual knowledge, and even more complex types of behavior. Indeed, many facts tend to show that the results and functional success of certain experiments in neurophysiology and in behavioral sciences have a different outlook whether performed in a newborn or in an adult. Certain personal clinical observations suggested the same conclusion. Long-term followup of patients born with lesions of the lower motor neuron type, mainly in Erb's palsy, but also in spina bifida1,2showed comparatively normal electrophysiological findings despite the prolonged atrophy and the loss of function. The electromyographic (EMG) findings were characterized by normal motor units, sometimes of low amplitude, recruited by stimulation or by

WILHELM HEINRICH ERB, 1840-1921

Erb's paralysis, a relatively uncommon malady, probably is the cause for most physicians' remembering the neurologist from Heidelberg.¹Erb's interest in clinical neurology, however, was broad and diversified and included many contributions beyond the localized lesion of the brachial plexus. A hypothesis for the etiology of tabes dorsalis, the descriptions of myotonia congenita and a juvenile form of progressive muscular atrophy, use of the term "tendon reflex," and studies on electrodiagnosis and electrotherapy are other accomplishments. William was born in the Black Forest in Bavaria, the son of a forester.²As a peripatetic student, typical of the German system of higher education, university studies were begun at Heidelberg and continued at Erlangen. At the age of 24, he received his MD degree at Munich. He selected internal medicine initially as his field of interest, but diverted later to neuropathology and clinical neurology. After a short term as professor

The occurrence of Erb's palsy in three siblings of one family.

The occurrence of Erb's palsy in three siblings of one family.

Paralytic Supination Contracture of the Forearm

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Unilateral diaphragmatic paralysis and Erb's palsy in the newborn.

<h3>Abstract</h3> <h3>Summary</h3> The Genome-Wide Association Studies (GWAS) are essential to determine the genetic bases of either ecological or economic phenotypic variation across individuals within populations of the model and non-model organisms. For this research question, the GWAS replication testing different parameters and models to validate the results’ reproducibility is common. However, straightforward methodologies that manage both replication and tetraploid data are still missing. To solve this problem, we designed the MultiGWAS, a tool that does GWAS for diploid and tetraploid organisms by executing in parallel four software, two designed for polyploid data (GWASpoly and SHEsis) and two for diploids data (GAPIT and TASSEL). MultiGWAS has several advantages. It runs either in the command line or in a graphical interface; it manages different genotype formats, including VCF. Moreover, it allows control for population structure, relatedness, and several quality control checks on genotype data. Besides, MultiGWAS can test for additive and dominant gene action models, and through a proprietary scoring function, select the best model to report its associations. Finally, it generates several reports that facilitate identifying false associations from both the significant and the best-ranked association SNP among the four software. We tested MultiGWAS with public tetraploid potato data for tuber shape and several simulated data under both additive and dominant models. These tests demonstrated that MultiGWAS is better at detecting reliable associations than using each of the four software individually. Moreover, the parallel analysis of polyploid and diploid software that only offers Multi-GWAS demonstrates its utility in understanding the best genetic model behind the SNP association in tetraploid organisms. Therefore, MultiG-WAS probed to be an excellent alternative for wrapping GWAS replication in diploid and tetraploid organisms in a single analysis environment.