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Duchenne-Erb Palsy

The most striking manifestation of Duchenne-Erb palsy is the abnormal posture of the affected upper extremity when the neonate is moving the healthy arm (Figure 216.1). This posture consists of adduction and internal rotation of the shoulder, extension of the elbow, pronation of the forearm, and flexion of the wrist and fingers. There is minimal weakness of the extensors of the wrist and no finger weakness.

A
B

Figure 216.1.— Typical posture of a neonate with Duchenne-Erb palsy [A and B]. The posture consists of arm adduction and internal rotation, extended elbow, forearm pronation, palmar flexion of the wrist, and good finger movements. The presence of wrist flexion indicates minimal or no involvement of C7.

Duchenne-Erb palsy indicates involvement of C5 and C6 spinal segment fibers. The most frequent site of involvement of these fibers is at the upper trunk prior to the origin of the suprascapular nerve (Figure 216.2 B), but more proximal damage can also occur (Figures 216.2 A). The clinical manifestations of Duchenne-Erb palsy are so typical that it can not be confused with a lesion at any other location.

Figure 216.2. Schematic representation of the brachial plexus and its nerves and muscles. Site of injury. A: C5 root and C6 spinal nerve; B: upper trunk; (PS): paraspinal muscles; (R): rhomboid muscle; DS: dorsoscapular nerve; LT: long thoracic nerve; (SA): serratus anterior muscle; (SS): supraspinal muscle; (IS): infraspinal muscle; SPS: suprascapular nerve; PL: pectoral lateralis nerve; (P): pectoralis muscle; PM: pectoralis medialis nerve; SF: sympathetic fibers to the eyes; (M of M): muscle of Müller; (DP): dilator pupillary muscle; (TM): teres major muscle; (SBS): subscapularis muscle; SBS: subscapularis nerves; TD: thoracodorsal nerve; (LD): latissimus dorsi muscle; MC: musculocutaneous nerve; (Bi): biceps muscle; (Br): brachialis muscle; M: median nerve; U: ulnar nerve; A: axillary nerve; (TMi): teres minor muscle; (D): deltoid muscle; R: radial nerve.

 

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sympathetic fibers dilator pupillary muscle muscle of Muller radial nerve ulnar nerve musculocutaneous nerve musculocutaneous nerve brachialis muscle biceps muscle axillary nerve deltoid muscle teres minor muscle latissimus dorsi muscle thoracodorsal nerve subscapularis muscle teres major muscle subscapularis nerve serratus anterior muscle long thoracic nerve pectoralis medialis nerve pectoralis muscle pectoralis muscle pectoralis lateralis suprascapular nerve infraspinal muscle susupraspinal muscle dorsoscapular nerve rhomboid muscle lower trunk middle trunk upper trunk ventral ramus ventral ramus spinal ganglion dorsal ramus paraspinal muscle intervertebral foramina intervertebral foramina intervertebral foramina intervertebral foramina intervertebral foramina radial nerve axillary nerve ulnar nerve median nerve musculocutaneous nerve branches branches medial cord posterior cord lateral cord divisions divisions trunks trunks rami rami spinal nerves spinal nerves roots roots spinal cord spinal cord Piatt, 1991 To identify a structure pause the pointer over the abbrevations, or the structure in question; to idenyify the sites of injury pause pointer over the letters; do not click. Not all structures are labeled. Figure must be centered. Would you like know more about the muscles affected?