upper brachial plexus injury
Upper plexus lesions affect mostly C5 and, less frequently, C6. They are usually due to trauma, for example falling on the shoulder, or traction on the arm at birth - in which case the name Erb Duchenne paralysis is given.
The arm hangs at the side with the elbow extended and the forearm pronated; the so-called waiter's tip or Erb's palsy.
On examination, there is loss of:
- shoulder abduction - deltoid, supraspinatus
- external rotation - infraspinatus
- elbow flexion - biceps, brachialis
There may be a slight loss of shoulder adduction.
Treatment is by placing the arm in an abduction splint with a movable joint at the elbow. The prognosis is better for lesions in the neonate than the adult.
Last reviewed 01/2018