Infantile plexus palsy is arm paralysis that affects newborns. It results from overstretching, tearing, or avulsion of nerve roots at birth. In addition to physical and occupational therapy, microconstructive measures can restore the mobility and sensitivity of the affected arm during the first months of life, and intensive parental care also plays a role as a therapeutic measure.
What is infantile plexus palsy?
Infantile plexus palsy is the medical term for infantile paralysis of the arm that occurs during birth due to an injury to the nerve plexus. Infantile arm paralysis varies in severity and thus restricts arm movement to varying degrees. At the same time, a more or less severe disturbance of arm sensitivity occurs. Depending on the number of affected nerve roots, infantile plexus palsy may either regress or involve permanent movement restrictions.
Causes
Infantile palsy of the arm is always caused by damage to the arm nerve framework that occurs during the birth process. Usually, the damage results from abnormal stretching of the arm nerves and thus is usually associated with complications during the birth process. Such complications are present, for example, when the baby’s shoulder becomes entangled and obstetricians have to exert extreme pressure on the baby’s neck. However, mechanical birth aids such as forceps can also promote infant plexus palsy. Infants with a birth weight over 4000 grams are most commonly affected by the condition. Emergency situations such as umbilical cord entanglement during birth may also require action on the neck and cervical region and are therefore equally commonly associated with infantile arm paralysis. Less commonly, arm damage results from cesarean section or nerve root avulsion during breech delivery.
Symptoms, complaints, and signs
The brachial plexus lies over the clavicle and has five nerve roots to three nerve trunks. Thus, in addition to shoulder movement, it also controls flexion and extension of the elbow. Likewise, this nerve complex is responsible for hand movement and pectoral muscle movement. Depending on which of the five nerve roots are affected by the paresis, there is upper, middle or complete plexus paresis. The severity and location of the damage determine the symptoms. In complete plexus palsy with nerve root avulsion, the child cannot move the arm or the pectoral muscle. Sensations are also no longer present for these areas. If instead of an avulsion there is only a tear or overstretching, the ability to move, but also the sensitivity of the corresponding areas is limited, but not completely blocked. In upper plexus palsy, not all five nerve roots are affected. In this case, the sensitivity and movement restriction refers only to the shoulder and elbow area, with partial chest muscle involvement. Intermediate plexus palsy, on the other hand, involves only the pectoral muscle and extension of the elbow.
Diagnosis and course of the disease
The physician can often make the diagnosis of infantile plexus palsy by visual diagnosis. This is specifically true if the process of birth has been accompanied by complications that typically favor the manifestation. To confirm the diagnosis, the physician may order appropriate imaging. How infantile plexus palsy develops depends on the individual case and the number and intensity of the particular injuries. The corrective measures initiated also influence the course of the disease. If, for example, microsurgical nerve reconstruction can take place, a more positive course can be assumed under certain circumstances. If the paresis is accompanied by growth disorders of the arm, a more severe course of the disease with permanent damage can be predicted. Negative factors in individual cases may also be concomitant diseases, such as obesity. Due to the paralyses, extreme malpositions may occur in the affected arm under certain circumstances, which are accompanied by joint wear. Physiotherapeutic measures can be helpful to avoid such a disease progression.
Complications
As a rule, paralysis of the arms occurs in affected children.This paralysis can lead to various restrictions in the patient’s everyday life and thus also to delayed development. The quality of life of the affected person is significantly limited by this disease. In many cases, parents and relatives are also strongly affected by this disease and need psychological support. As a rule, stretching and bending of the arm is no longer possible without further effort, which not infrequently puts strain on the shoulder as well. It is not uncommon for the damaged areas to also suffer from insensitivity and other sensory disturbances. Patients can no longer perform certain things and activities in everyday life. In many cases, infantile plexus palsy also causes growth disorders, which can lead to secondary damage and complications in adulthood. The arms may also assume a malposition, causing further strain. Plexus palsy is treated by various therapies or by surgical intervention. No further complications occur. However, it cannot be predicted whether a positive course of the disease will occur.
When should you see a doctor?
If the newborn cannot move the arm and chest muscle properly, infantile plexus palsy may be the underlying cause. A doctor should be consulted if the discomfort has not disappeared after one day or if the child shows signs of pain. If the child is unable to extend or flex the arm at all, the hospital should be visited immediately. Prompt intervention is also necessary if other symptoms are added to the movement restrictions. Thus, paralysis symptoms, skin changes or behavioral abnormalities of the child must be clarified by a doctor in any case. Often, infantile plexus paresis is recognized immediately after birth and treated while the child is still in the hospital. Further visits to the doctor are indicated during and after the therapy. In general, arm paralysis must be treated over many years in order to permanently preserve and, in the best case, even improve the mobility of the arm. The parents and later the affected persons themselves should therefore consult the doctor regularly. In addition to the family doctor, an orthopedist or a physiotherapist can be consulted. Accompanying mother-child therapy is recommended.
Treatment and therapy
Treatment of infantile arm paralysis depends largely on which nerves are affected. For the first two weeks after birth, the arm is spared and immobilized as the nerve system may recover on its own from minor damage such as overstretching. Swelling and bruising should subside during this period. Only after these first days are occupational therapy and physiotherapy measures initiated, which are intended in particular to prevent malpositioning of the joints and are tailored to the child’s age-typical movements. In individual cases, part of the nerves in the early phase can also be restored by microsurgery. As a rule, this reconstructive intervention takes place in the first months of life. Neurolysis, for example, removes residual scars and thus improves the conductivity of the damaged nerves. Approximately three years after this procedure, tendon and muscle realignment may be able to improve the overall functionality of the arm. The care of the parents is of great importance in the context of all therapeutic measures. For example, excessive stress on the mother-child relationship due to the phenomenon should be avoided.
Outlook and prognosis
The prognosis of infantile plexus paresis is difficult to predict. Specific tests are needed to determine which nerves were affected or damaged at birth in the newborn to establish a further outlook for the course of the disease. In a large number of patients, with good medical care as well as comprehensive care by the parents, a complete recovery can be documented in the further course. There are various therapeutic approaches and targeted training that can be used to achieve recovery. Nevertheless, there is also the possibility that paralysis or partial paralysis will remain for life despite all efforts. The extent of the damaged nerve fibers provides information about the further course of the disease. If no restoration of the arm’s movement possibilities is achieved, further sequelae are to be expected.The immobility can lead to emotional and mental states of stress. In case of an unfavorable course of the disease, psychological disorders develop, which contribute to a significant deterioration of well-being as well as quality of life. The physical performance is limited due to the disease and can lead to a strong weakening of the psyche. Everyday life has to be restructured and adapted to the patient’s physical conditions. Depending on the individual personality traits as well as the patient’s environment, there is a risk for mental illness.
Prevention
Parents can prevent infantile plexus palsy as much as possible by placing themselves exclusively in the hands of experienced obstetricians at birth. However, in extreme birth complications, paralysis can occur even if obstetricians have a great deal of experience.
Aftercare
There are usually very few options for follow-up care available to the affected person with this condition. In this case, treatment must be initiated immediately to prevent permanent damage to the child, which can negatively affect the child’s life. In the worst case, permanent paralysis occurs, which can no longer be treated. In this case, the parents are dependent on intensive care for the child and must support it. First and foremost, physiotherapy measures are necessary to alleviate the symptoms, although many of the exercises can also be repeated at home. In the same way, the child needs the help of his own family and friends in everyday life. With further development, further surgical interventions may also be necessary to permanently alleviate the discomfort. After such an operation, the child should in any case rest and relax. No physical activities or efforts should be performed. The disease also does not reduce the life expectancy of the child, provided that it is treated quickly and properly.
What you can do yourself
In the case of infantile plexus palsy, permanent physiotherapy treatment is strongly advised. As part of physiotherapy, parents of affected patients are shown various exercises that they must perform several times a day with their children at home. Since infantile arm paralysis leads to physical limitations in everyday life, kindergarten, school, training and work places must be proactively informed about the problem. Sports activities, especially swimming, can have a positive effect on plexus paralysis and should be encouraged if the child is interested. Some swimming clubs offer special classes for children with movement disorders. Infantile arm paralysis should be discussed openly by parents with their children. An open approach to the movement disorder, depending on the character and age of the child, is a significant factor in self-help. Negative or pejorative-sounding terms for the affected limb, such as weak or broken arm, should be avoided. With older children and adolescents, conversations about their own body image are of utmost importance, because with the onset of puberty, their own body image often changes. If the child blocks or withdraws completely into himself, complementary psychological or psychotherapeutic treatment of the patient is recommended with the goal of increasing self-esteem.
