Quotation from: Manual of SurgeryWritten by: Alexander Miles and Alexis Thomson |
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In the _brachial birth-paralysis_ met with in infants, the lesion is due to over-stretching of the plexus, and is nearly always of the Erb-Duchenne type. The injury is usually unilateral, it occurs with almost equal frequency in breech and in vertex presentations, and the left arm is more often affected than the right. The lesion is seldom recognised at birth. The first symptom noticed is tenderness in the supra-clavicular region, the child crying when this part is touched or the arm is moved. The attitude may be that of the Erb-Duchenne type, or the whole of the muscles of the upper limb may be flaccid, and the arm hangs powerless. A considerable proportion of the cases recover spontaneously. The arm is to be kept at rest, with the affected muscles relaxed, and, as soon as tenderness has disappeared, daily massage and passive movements are employed. The reaction of degeneration can rarely be satisfactorily tested before the child is three months old, but if it is present, an operation should be performed. After operation, the shoulder should be elevated so that no traction is exerted on the affected cords.
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