Chassaignac Palsy: Causes, Symptoms & Treatment

Chassaignac palsy occurs primarily in young children up to four years of age. In this case, the so-called head of the radius in the elbow joint is dislocated. This is only possible in toddlers, because from the age of four the radial head reaches its final size. Basically, a distinction is made between Chassaignac’s palsy and elbow dislocation, although the transitions are usually fluid for the layperson.

What is Chassaignac palsy?

Elbow dislocation refers to the dislocation of the elbow joint. This is located between the humerus and the ulna. In contrast, Chassaignac’s palsy can only be referred to as a partial dislocation in that the head of the radius pops out of the annular ligament. Elbow dislocation can affect both children and adults. Chassaignac palsy, on the other hand, is only possible in young children.

Causes

Chassaignac palsy is basically caused by a jerky pull. In most cases in which Chassaignac palsy is triggered, the child in question stumbles and the parents try to keep him or her from doing so while still holding onto the arm. This strong jerk can cause dislocation of the radial head. Also, pulling the child back when he or she wants to run ahead can, under certain circumstances, trigger such a large jerk that Chassaignac palsy can also result.

Symptoms, complaints, and signs

Chassaignac palsy can lead to very unpleasant symptoms that generally have a very negative impact on the quality of life and on the daily life of the affected person. First and foremost, Chassaignac palsy thereby leads to a protective posture of the arm. This means that the joint is not loaded, so that pain is avoided. If the joint is loaded, the affected person suffers from severe pain and thus from restricted movement. Since Chassaignac palsy occurs in early childhood, the children’s development is also considerably restricted. As a result, the affected children cannot play properly or participate in other activities. If the pain caused by Chassaignac palsy also occurs at night, it can lead to severe psychological upsets or even depression. Likewise, sufferers often suffer from swelling in the arm, which also reduces the aesthetics of the affected person. Chassaignac palsy also leads to paralysis or various disorders of sensitivity at the elbow of the affected person. Self-healing does not occur with this disease, so sufferers are dependent on medical treatment in all cases. However, the paralysis does not negatively affect or reduce the life expectancy of the affected person.

Diagnosis and course

The child will hold the affected arm still in Chassaignac palsy. In most cases, the arm is simply held down quietly. One can speak of holding the arm in a neutral position, so to speak. The forearm and also the hand are held slightly inward by the child to protect the joint. This behavior is called pronation. The child will not move this arm and may also suffer from great pain. Furthermore, there may be swelling just above the radial head and numbness, both in the hand and in the forearm. AChassaignac palsy is usually recognized by the treating physician immediately by the corresponding posture and the other symptoms and usually requires no further diagnosis.

Complications

Chassaignac palsy results in very severe pain that can be extremely distressing, especially for children. However, the pain occurs only at the beginning of the disease, disappearing afterwards. The child’s arm is paralyzed and can no longer be moved. In this case, the child no longer turns or moves the forearm in particular, resulting in severe limitations in everyday life. It is no longer possible for the patient to grasp or take certain things or to use the arms, for example, to play. Therefore, Chassaignac palsy also prevents the child from developing. If the paralysis is not treated, it can become permanent, making the patient’s daily life very difficult. Even after successful treatment, there is a small risk of the paralysis recurring in the patient. No further complications occur during the treatment itself.This can be done by the doctor directly with a special handle and relieves the patient directly from the symptom. If there is pain or other injury to the arm, it may remain in a cast for several days after treatment. Pain may also still occur after the treatment. No other complications will occur.

When should you see a doctor?

If Chassaignac palsy is suspected, a doctor should be consulted in any case. Only a medical professional can return the dislocated radial head to its original position and thereby also resolve the discomfort. So if you suddenly experience slight pain in the area of the elbow that cannot be attributed to any other cause, medical advice is called for. Other warning signs that require clarification are paralysis symptoms that seem to occur quite suddenly and sometimes also a slight redness in the bend of the elbow. Parents who notice such symptoms in their child are best to make an appointment with a pediatrician immediately. Immediate treatment prevents the symptoms from worsening and usually brings rapid relief. However, if Chaissagnac palsy is left untreated, further complications may develop and the symptoms will continue to increase as the condition progresses. Therefore, the following applies: consult a doctor immediately if the child – mainly small children up to the age of five are affected – suddenly no longer uses one arm or only uses it to a limited extent or complains of pain.

Treatment and therapy

The first step in treatment is usually an x-ray of the affected arm. This is to detect any bone fractures that may have been involved. However, this is not the rule in Chassaignac’s palsy, but it is performed for safety in case of corresponding symptoms, for example, after a severe fall. Afterwards, the doctor will try to reset the head of the radius. This is done very quickly, as prolonged bruising or overstretching of the neighboring nerves and blood vessels should be prevented. Otherwise, unpleasant consequential damage could occur. Before the dislocation takes place, the affected child is usually injected with a painkiller and sedative. This is to prevent the child from tensing his or her muscles and making it more difficult to set the spine. In most cases, this step is performed without any problems and the child can then move his or her arm as usual. After the dislocation, however, the arm is usually examined again. The attending physician pays particular attention to ensuring that the elbow joint is sufficiently stable. This is because the joint ligaments and joint capsules may have been damaged or, in some cases, completely torn when the head of the radius popped out. This can cause the radial head to pop out again quickly. Furthermore, the physician will clarify whether sensory disturbances in the arm exist and are not receding. If this is the case, this may indicate an injury to a main artery. Damage to the nerves could also have been caused. If severe instability is found, surgery must be performed to prevent permanent damage. To be on the safe side, the affected child is usually put in a plaster splint for about two to three weeks to prevent it from popping out again. Physiotherapy may also be ordered if the ability to move cannot be restored on its own. However, this is usually only necessary in very severe cases. In the case of a dislocation caused by a “normal” jerk, the child can move the arm without any problems after the dislocation and also has no more pain. Even prior injection of painkillers and sedatives is often essential.

Outlook and prognosis

In most cases, Chassaignac palsy does not cause permanent or long-term damage. This is especially the case if the injury is immediately controlled by a doctor who can reset the head. This will not damage any nerves, so there will be no further discomfort. The child can move the arm without any restrictions after the head has been set. As a rule, however, some examinations are still necessary after the dislocation in order to detect further damage. If there is instability, it can be treated by surgery and subsequent physiotherapy. Mobility is usually not negatively affected by this and can be fully restored.Surgical interventions are necessary only rarely and in severe cases of severe injuries. The dislocation itself can be associated with pain, but afterwards there is no more pain when moving. In most cases, Chassaignac palsy can be treated completely, resulting in a positive course of the disease. Complications can only occur if treatment is delayed.

Prevention

Care should thus be taken not to pull your child’s arm too hard to prevent Chassaignac palsy.

Aftercare

In Chassaignac palsy, aftercare measures are usually severely limited or not available to the affected person at all. First and foremost, the condition must be detected early and treated by a physician to prevent this paralysis from becoming permanent and causing further complications or discomfort. The earlier the Chassaignac paralysis is detected and treated, the better the further course of this disease usually is. In general, the activity that led to the Chassaignac palsy should be avoided. After the accident, the affected area should be immobilized and no further weight should be placed on it. The patient should refrain from strenuous or physical activities in order not to put unnecessary strain on the body. In some cases, physiotherapy is also necessary for this disease, although the affected person can also perform some of the exercises themselves in their own home and thus accelerate the healing process. Since the disease usually occurs in young children, parents should always support the children during treatment and give them a good talking to. In case of severe pain, painkillers should be administered, although these should not be taken over a long period of time. After treatment, regular checkups with a doctor continue to be very useful.

This is what you can do yourself

Chassaignac palsy is a partial dislocation of the elbow in which the radial head pops out of the annular ligament. This disorder can only occur in young children, as the radial head usually reaches its final size during the fourth year of life. In the case of Chassaignac palsy, quick action is required on the part of a toddler’s parents or caregivers. If the injury is not recognized or treated promptly, the paralysis may become permanent or be associated with severe long-term consequences. Chassaignac palsy usually causes severe pain at the onset. Parents should always take such complaints very seriously and consult a doctor, even if no serious act of injury appears to have preceded it. Most often, jerky movements cause Chassaignac palsy. This may be the case when children tug on each other’s arm while playing or when parents are just able to hold a falling child by the arm. Often, the trigger for the disorder is completely unspectacular. It becomes dangerous when the children are not in acute pain and the dislocation is therefore not recognized immediately. Parents should therefore always react promptly to certain behaviors. Even if children are not in pain, they usually cannot move the arm affected by Chassaignac palsy or try to spare it. Parents who observe such behavior should seek immediate medical attention, even if the child does not complain of discomfort.