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Prenatal brachial plexus paralysis
G Paradiso1, N Grañana, E Maza
1Department of Neurology, Hospital Nacional de Pediatría Juan Garrahan, Buenos Aires, Argentina.
Insights
Early EMG testing is crucial for diagnosing Erb's palsy in newborns. This diagnostic tool helps identify brachial plexus injuries that occurred before birth, guiding timely medical and legal interventions.
Area of Science:
- Neurology
- Pediatrics
- Clinical Electrophysiology
Background:
- Congenital brachial plexus injuries, such as Erb's palsy, can result from difficult deliveries.
- Accurate diagnosis is essential for appropriate management and medicolegal considerations.
Observation:
- An 18-day-old infant presented with symptoms suggestive of brachial plexus injury, specifically affecting C5-C6 muscles.
- Electromyography (EMG) revealed high-voltage polyphasic motor unit potentials without abnormal spontaneous activity.
Findings:
- The clinical presentation and EMG findings indicated a brachial plexus injury that likely occurred antenatally, weeks prior to delivery.
- Comparison with 100 EMG examinations in 78 children with Erb's palsy supported this diagnostic conclusion.
Implications:
- Early EMG testing is recommended for all infants with congenital brachial paralysis to facilitate prompt diagnosis.
- Timely diagnosis of brachial plexus injuries has significant clinical and medicolegal importance.
Abstract:
An 18-day-old child with a history of difficult breech delivery presented with wasting and weakness of C5-6-innervated muscles. The EMG examination performed the same day showed high-voltage polyphasic motor unit potentials without abnormal spontaneous activity. Both the EMG pattern and the clinical features suggest an injury taking place several weeks before delivery. This presumption seems confirmed when compared with findings in our series of 100 EMG examinations in 78 children with diagnosis of Erb's palsy. Because of both clinical and medicolegal implications, early EMG testing is advisable in all patients with congenital brachial paralysis.