Duchesne-Erba paralysis: causes and treatment
The development of medicine is continuous. Every day, scientists invent new drugs, offer improved methods of conducting operations. Despite significant progress in this area, the problem of birth trauma remains relevant. The greatest danger is not the pathology itself, but its consequences. A vivid example of a neurological disorder that a child can get in the process of delivery is damage to the brachial plexus. If there is a change in the structure of the cervical vertebrae, Duchesne-Erba paralysis is diagnosed. The main causes of pathology and methods of treatment will be discussed below.
Brief description of the disease
Disease of the nervous peripheral system, which develops as a result of damage to the brachial plexus, is called Duchenne-Erba paralysis. Usually it is preceded by birth trauma. Therefore, pathology is often referred to as obstetric paralysis. However, this is not the only reason for this condition.
It is characterized by muscular weakness in the upper limbs, limitation of mobility in the shoulder and elbow joints. It is also possible to violate the sensitivity, but the motor skills of the brushes are preserved. Dushen-Erba's obstetric paralysis can not be overcome if one uses a general therapy regimen. Treatment is always selected individually. One patient after the examination, the doctor prescribes the medication, the other - physioprocedures. In particularly serious cases, surgical intervention is required. The prognosis for recovery depends on the severity of the pathology and the completeness of its treatment.
Historical background and some statistics
Duchesne-Erba paralysis derives its name after two neuropathologists. They first detailed the etiology and clinic of the disease. The French doctor G. Duchene for several years studied the state of small patients after severe childbirth. In 1872, he summarized the information received and presented a detailed description of the manifestation of paralysis in infants. In parallel, the study of the disease involved another doctor from Germany, W. Erb. He managed to describe the anatomical picture of the development of the disease and the pathogenesis of this process in adults.
According to statistical data, obstetric paralysis of Duchesne-Erba belongs to the category of rare pathologies. Currently, this diagnosis is confirmed in every thousandth newborn. Despite the constant improvement of obstetric methods, the disease remains an urgent problem of modern medicine.
Causes of paralysis in newborns
Duchene-Erba paralysis in newborns develops on the background of traumatism of the brachial plexus. In the process of delivery, the obstetrician is forced to take various actions to help the child to be born. It should be noted that such measures are resorted only in case of emergency. During such manipulations are possible:
- traumatizing stair muscles;
- stretching of the brachial plexus, tears of neural bundles;
- slight bleeding in the affected area.
If the fetus is too large and its parameters do not correspond to the dimensions of the birth canal, the risk of damage to the shoulder joint increases several times. To help the baby appear, midwives are forced to use special tools. With sudden movements, the brachial plexus of nerve fibers is broken.
Causes of Paralysis in Adults
In older children and adults, the development of pathology is usually associated with trauma. Among such mechanical damages are:
- traction by hand;
- neck injury;
- injury in the brachial plexus region;
Sometimes brachial plexus damage occurs due to a car accident. Very rarely paralysis of Erba-Duchene in adults occurs due to toxic or infectious damage. The development of the pathological process can be caused by tuberculosis infection, occurring in a complicated form, typhoid and malaria.
What are the symptoms that indicate an ailment?
With the development of the so-called flaccid paralysis, the loss of functions of a number of muscles( biceps, deltoid, humerus) is noted. The degree of severity of symptoms depends on the nature of the damage to the fibers, impaired conduction of impulses.
In most newborns, Duchesne-Erb's paralysis is clearly manifested in the first days of life. The child becomes excessively restless and constantly cries. The cause of the disorder is severe pain in the limb. Also, the following symptoms may indicate damage to the brachial plexus:
- an arm that is always bent at the elbow;
- decreased muscle tone;
- weakened breathing;
- grasping the arm in the cam with the thumb;
- pallor of the skin.
Despite the lack of activity of a sick hand, children often have weak intensity movements. However, if the newborn is placed horizontally on the palm of your hand, the affected limb will hang slightly.
Stages in the course of the pathological process of
The Duchesne-Erba paralysis develops in several stages.
The acute stage lasts from a few hours to 2-3 days. At this time there is a decrease in the activity of the hands, a difficulty in the process of flexing the arm at the elbow.
Then comes the recovery phase. With proper treatment, correction of lost functions can take several years. As a result, edema in the area of nerve fiber damage disappears, and blood circulation is completely restored.
After this comes the stage of residual phenomena, which can last the rest of your life. Therefore, it is so important during the recovery period to actively engage in treatment. At the stage of residual phenomena, any therapeutic measures are most often ineffective. In the patient, the affected limb is gradually hypertrophied, and in serious lesions it looks underdeveloped. The shoulder blade on the patient side turns out, its edge moves away from the spine. Over time, these changes lead to a curvature of the spine - scoliotic deformation.
How is diagnostics performed?
Examples of studies of Duchenne-Erb's paralysis still attract scientists from all over the world. However, today the diagnosis of the pathological process no longer causes special difficulties. At occurrence of its first signs the pediatrist should direct the newborn on consultation to the neuropathologist and the orthopedist. In adult patients, these specialists also deal with the treatment of the disease. To diagnose a neurologist should study the patient's anamnesis, conduct a physical examination. Then they proceed to a more detailed examination, which includes:
- computer myelography;
- of the ultrasound of the shoulder joint.
Usually external manifestations of the disease are sufficient to confirm pathology. All information must be recorded in the patient's medical records. The doctor makes a note, diagnoses "Erba-Duchene paralysis".ICD-10 awarded the disease code P14.0.
However, in order to identify the nature of the damage, the above studies are required. Each of the diagnostic methods carries a certain task and can not be replaced by another. Based on the results of the tests, the doctor can prescribe treatment, as well as give a forecast for the future.
Treatment of paralysis begins with conservative methods. In the acute period, it is not always possible to determine the degree of damage to the fibers due to severe edema of the tissues. Therefore, surgical manipulation is considered impractical.
What medicines are used to combat such a pathology as Duchesne-Erba's upper paralysis?
- Non-steroidal anti-inflammatory drugs: Ibuprofen, Amidopyrine.
- Drugs for improving blood circulation: Pentoxifylline, Papaverin.
- Anticholinesterase medications that enhance the conduct of nerve impulses: Neurromidine, Galantamine, Prozerin.
- Preparations for the normalization of metabolism: "Actovegin", "Mexidol", vitamin complexes.
As the patient's condition improves, the dosage of medication and the regimen are changed.
Fighting the pathological process involves a so-called treatment of the situation. A tire is placed on the diseased limb, which can be removed only for the period of hygiene procedures.
To maintain muscle tone, the following activities are shown:
- massage of the affected limb( starting from the second week);
- muscle electrostimulation;
- medical gymnastics with passive exercises;
- paraffin applications;
A positive effect of conservative therapy is possible only if the brachial plexus fibers are partially damaged. He is expected for about three months, after which he goes on to evaluate the results. If by this time the patient does not have active movements in the elbow joint, the question of surgery is being decided.
The essence of the operation is to restore the integrity of damaged fibers. For this, the plastic of the nerve trunk is performed. Currently, this is the only operation that can help patients with a diagnosis of "Duchesne-Erba paralysis".Treatment performed in the first year of life of a small patient gives the best results. The operation itself does not remove symptoms of the pathological process. It allows us to restore the way in which nerve impulses move forward. Further conservative treatment with application of exercise therapy, massages is shown.
Forecast for the future
It should be understood that the treatment of obstetric paralysis is a long and painstaking task that requires patience. It is necessary to follow all the doctor's recommendations in order to get a positive result. Many procedures are stretched for months, especially for exercise therapy and massage.
How can Duchenne-Erba paralysis end: disability or recovery? Unfortunately, it is not possible to give an exact answer to this question. It all depends on factors such as:
- severity of damage;
- timeliness and adequacy of therapy;
- desire to comply with all the doctor's recommendations.
With partial defeat of the brachial plexus, one can hope for a 100% recovery. At least, this is what statistics say. With a full breakdown of the chances, unfortunately, much less.
Is it possible to prevent Duchess-Erba paralysis? Photos of young children who had to face this disease, really make us think about this issue.
In fact, the prevention of pathology is quite simple. It implies adequate management of pregnancy, the correct choice of the method of delivery. Even at the planning stage, you need to take care of your condition, try to eat right and do not neglect sports. A healthy woman has a better chance of having a baby without pathologies. In addition, the choice of a medical institution, where the future mother decides to be observed, should be treated responsibly. It is necessary to read reviews about obstetricians, the process of delivery in this clinic. You can also consult with friends who have already tried on the role of mother. During the very pregnancy itself it is important to listen to the advice of a gynecologist, not to ignore his recommendations.