The History of Erb's Palsy and Brachial Plexus
Palsy
Erb was reported around the same time that brachial plexus injuries
were being noted and Erb and Duchenne have been associated to this particular
form of brachial plexus palsy as it is referred to as Erbs-Duchennes
palsy. Later on someone by the name of Klumpke described the clinical
picture of injury to the lower plexus. It was observed to cause paralysis
of the hands muscles and as associated dilation of the eyes
pupil on the side of the injury. Klumpkes name was associated to
this particular form of brachial plexus palsy when observed in infants
and continues to be called Klumpkes palsy.
Duchenne recommended in the 1870s treating brachial plexus palsy
with electrical stimulation of the paralyzed muscles. The brachial plexus treatment was
very uncomfortable to the child and did not become a favorable form of
treatment. Different forms of splinted positions were then recommended
as to avoid the secondary complications due to progressive muscle contracture.
Other forms of brachial plexus treatments were tried with varying degrees
of success to help the arm deformity associated to brachial plexus, including
tendonotomies, cutting of contracted muscle tendons to gain additional
movement blocked by the contracted muscle, capsulotomies, cutting of
capsule of a frozen joint, and rotational osteotomies, cutting through
the bone of the upper arm and rotating it into a better positioning and
fixating it with a plate.
In 1903 a man by the name of Kennedy was the first to describe surgical
exploration of 3 infants necks that had sustained injury to the
brachial plexus. Kennedy found injured C5 and C6 roots in all of the
babies and resected the zone of injury to the nerves and sewed the cut
ends back together. Kennedy found the surgical brachial plexus exploration
to be encouraging. Clark followed up with a report in 1905 that found
similar findings as well as a 29% mortality rate associated with the
brachial plexus surgery. Later, in 1920, a group of 70 infants endured
the brachial plexus surgery with only one death resulting from the surgery.
The surgery on the brachial plexus appeared to be a break through until
1922 when Bentzon advised against surgery because he found the outlook
for the infants untreated to be good and the published outcomes of the
infants who had been through brachial plexus surgery as unimpressive.
Sever released a review in 1925 of 1,100 infants that he had treated
and concluded that many of the infants who had brachial plexus surgery
had very little gain. Sever felt that physiotherapy and bracing were
more beneficial than the brachial plexus surgery. Then in 1930 Lauwers
concluded that the morbidity and mortality that was associated to the
brachial plexus surgery was excessive and should be avoided. After all
these conclusions from various people, brachial plexus surgery was abandoned.
A report in 1980 by Gilbert brought up brachial plexus surgery once
again. In the mid-1980s Gilberts group was supporting the
surgical exploration of any infant that showed no brachial plexus movement
at three months after birth. Every case that he saw he found the injury
requiring excision of injured nerve tissue and grafting. When he analyzed
his results of 178 children two years following brachial plexus surgery,
he found that the children experienced one grade higher of improvement
than compared to a non-brachial plexus surgery child on average. Since
then many different groups have had positive regard for brachial plexus
surgery and it is still being performed on brachial plexus palsy injuries
today.
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