Makindo Medical Notes

Introduction

Peripheral nerve injuries and palsies in children can result from a variety of causes, including trauma, congenital abnormalities, and during the birth process. The resulting motor and sensory deficits can impact a child's development, and early recognition and intervention are key to improving outcomes.

Aetiology

• Birth Trauma: Injuries to the brachial plexus during difficult deliveries, such as shoulder dystocia, can lead to conditions like Erb’s palsy and Klumpke’s palsy.
• Trauma: Falls, accidents, or sports injuries can result in peripheral nerve damage.
• Congenital Conditions: Some children are born with conditions like congenital muscular dystrophy or hereditary motor sensory neuropathies, which can result in nerve palsies.
• Infections: Viral infections like varicella zoster or Guillain-Barré syndrome can lead to nerve inflammation and weakness.
• Tumors: Nerve compression due to tumors or cysts may cause palsies.

Clinical Features

• Muscle Weakness: The affected area often exhibits weakness or paralysis, with the severity depending on the extent of nerve damage.
• Loss of Sensation: Sensory deficits can occur, especially in cases of nerve root involvement or compression.
• Atrophy: Muscle wasting can develop in chronic cases due to lack of use.
• Pain: Some children may experience pain, although it is less common in infants.
• Abnormal Reflexes: Diminished or absent reflexes may be noted, particularly with more severe injuries.

Types of Peripheral Nerve Palsies

• Erb’s Palsy (Upper Brachial Plexus Palsy): Commonly caused by birth trauma during shoulder dystocia, resulting in weakness or paralysis of the upper arm (C5-C6 roots). Classic signs include “waiter’s tip” posture, with the arm adducted and internally rotated.
• Klumpke’s Palsy (Lower Brachial Plexus Palsy): Involves the C8 and T1 nerve roots, leading to paralysis of the hand and wrist, with a characteristic “claw hand” appearance.
• Radial Nerve Palsy: Results in wrist drop, with inability to extend the wrist and fingers. It can be caused by compression or injury to the radial nerve.
• Peroneal Nerve Palsy: Caused by compression or injury to the peroneal nerve, resulting in foot drop and difficulty in dorsiflexion of the foot.
• Facial Nerve Palsy (Bell’s Palsy): Weakness or paralysis of the facial muscles, usually on one side of the face, causing drooping of the eyelid and corner of the mouth.

Diagnosis

• Clinical Evaluation: A thorough history and physical exam to assess muscle strength, tone, and reflexes.
• Electromyography (EMG): Helps assess the degree of nerve damage and the presence of denervation in the muscles.
• Nerve Conduction Studies: Used to evaluate the speed and efficiency of electrical impulses traveling along the nerves.
• Imaging: MRI or ultrasound may be used to identify nerve compression, tumors, or structural anomalies.

Management

• Physical Therapy: Essential for restoring function and preventing muscle atrophy, especially for cases involving the brachial plexus.
• Occupational Therapy: Helps with hand and wrist function, particularly for children with Klumpke’s palsy or other hand dysfunctions.
• Surgical Intervention: In severe cases, surgery may be required, including nerve grafting or tendon transfers, to improve function.
• Pain Management: Analgesics and anti-inflammatory medications may be used if pain is present, particularly in acute traumatic injuries.
• Bracing: Splints or orthotic devices may help with posture, mobility, or to support weakened limbs.

Prognosis

• The prognosis depends on the extent of nerve injury and the timeliness of treatment.
• Many children with Erb’s palsy or Klumpke’s palsy recover with physical therapy, but some may experience permanent deficits.
• Early intervention can significantly improve outcomes, particularly for congenital or traumatic nerve injuries.

Prevention

• Proper Delivery Techniques: Preventing shoulder dystocia during childbirth can reduce the risk of brachial plexus injury.
• Avoiding Traumatic Injuries: Proper protective gear during sports and activities can reduce peripheral nerve injuries.