Improper management of labor and childbirth processes increases the risk of complications in mothers as well as babies. Certain maternal factors like cephal-pelvic disproportion is associated with a number of birth complications like shoulder dystocia that increases the risk of brachial plexus injury. Erb's palsy affects at least 2 to 3 babies per 1000 live-births globally and most cases are associated with mild stretching or spraining of nerve roots of upper trunk of brachial plexus that resolves spontaneously without any medical or surgical management. However, almost 20 to 30% cases are associated with significant tearing and permanent damage to nerve roots leading to significant disability.
There are a number of factors that increase the risk of birth trauma, resulting in damage to brachial plexus. Some of these include spontaneous vaginal delivery in babies with birth weight more than 9 pounds, mothers with relative or absolute cephalo-pelvic disproportion, complicated delivery (marked by prolong or obstructed labor), use of instruments like vacuum or forceps in the delivery process, and when the baby is breech at the time of birth (recognized complications like shoulder dystocia are fairly common).
Management of Erb's Palsy requires a multi-disciplinary approach in pediatric patient since most interventional therapies like surgeries are neither needed nor tolerated by young babies. Most healthcare professionals try to manage the cases by conservative approach or by supporting the connective tissue until the nerve heals itself in a few months. Since in some cases trauma is moderately severe, a surgical intervention may be required when the baby turns 2 or 3 years; however, an earlier chiropractic adjustment may prevent surgical or other types of intervention later in the course. Nerve growth and development is fairly high in the first few months post birth. It is therefore recommended to stabilize the pediatric patient as early as possible in order to prevent permanent damage to nerves and connective tissue components.
The most common approaches utilized in pediatric patients include careful observation and watchful waiting if damage to nerve fibers is not severe, moderate physical therapy exercises to maintain healthy circulation and to prevent disuse atrophy of muscles, and chiropractic adjustment and muscle stimulation therapies in order to correct traumatic injuries to nerves and spinal vertebrae during childbirth.
SL Harris reported an infantile case of Erb's Palsy in a baby who presented to the chiropractic office with a significant limp in the left arm after a complicated childbirth. SL Harris performed various chiropractic adjustments that include muscle stimulation therapy and spinal adjustment of the mid-cervical spine. In just a small duration of 2 months, the child improved tremendously and only a mild residual waiter's tip deformity was observed at the end of therapy.
Harris suggested that if chiropractic adjustments and therapies are performed earlier in the course, significant improvement can be observed. This is attributed to the massive pace of recovery in young babies (that decreases progressively with growth and development). Moreover, if treatment is delayed, the disuse atrophy and wasting of connective tissue components decrease the efficacy of manipulation and adjustments.
Another report published in Chiropractic and Manual therapies, author Allan Gotlib discussed the positive influence of chiropractic care in the management of infantile Erb's Palsy. To support his point, he reviewed over 177 descriptive studies (that were mostly case studies), 10 randomized control trials, 31 conference abstracts and 3 observational studies that were performed by various chiropractors for the management of Erb's palsy and related cases of brachial plexus injury.
Chiropractic care can be delivered to pediatric aged children as old as 12 to 15 years to manage Erb's Palsy diagnosed at birth. Richard A Carr-Hyde reported one such case in which an infantile Erb's palsy was treated at the age of 12 years in a female child with considerable success. He suggested that if no intervention is performed, considerable deformities may result like elbow articular deformities or permanent defects in the development of functional shoulder joint.
In case of any birth trauma or complicated childbirth, it is recommended to conduct a detailed examination to assess the degree and extent of possible nerve damage in order to seek early treatment and interventive management like chiropractic care.
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