There are different types of brachial plexus injuries. Children with Erb’s palsy are all affected in different ways. The variations are that some children will not have any muscle control or feeling in the arm or hand while some children can move their arms but have little control over the wrist and hand with other children able to use their hands well but can’t use their shoulder or elbow muscles. Depending on the type of nerve damage in Erb’s palsy children the symptoms can range from mild to severe. With Erb’s palsy, there are four different types of nerve injuries, including:
- An avulsion meaning the nerve is torn from the spine
- A rupture meaning the nerve is torn but not where it attaches to the spine
- A neuroma meaning the nerve has tried to heal but scar tissue has grown around the injury and the scar tissue puts pressure on the injured nerve
- Praxis meaning that the nerve has been damaged but not torn but improvement should be seen within 3 months.
Neuropraxia is the mildest form of a nerve injury. Neuropraxia, the most common form of Erb’s palsy is only at the specific place where the injury occurs and is a physiologic block of nerve conduction within an axon without any anatomical interruption. Many infants born with brachial plexus palsy have neuropraxia and sometimes recover spontaneously because it sometimes disappears within 4-6 weeks.
Axonotmesis nerve damage in Erb’s palsy injuries is characterized by axonal and myelin sheath damage that ends with a partial interruption of the connective tissue framework. This form of Erb’s palsy requires a re-growth of the axon to the target muscle. A complete absence of sensory modalities should be expected though recovery is fairly good.
Neurotmesis is the greatest degree of nerve injury in Erb’s palsy. There is complete disruption of the axon and supporting connective tissue. At birth, Erb’s palsy is associated with neurotmesis and has no recovery. One or more of the nerves in the brachial plexus may be affected and injured and may be the same type of injuries or different. Due to the fact that the injuries cause the same symptoms, it is hard to distinguish what type of injury has occurred.
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