Child Orthopedics


Frequently Asked Questions

Our first grandchild was born last week. Unfortunately, there's something wrong with his hand. They say it's some kind of nerve palsy. Is this a permanent problem?

Paralysis of the hand present at birth may resolve completely with time. It depends on the cause of the problem and the extent of the nerve involvement. Brachial nerve palsy is the most common cause of arm and hand paralysis at birth. The brachial nerve plexus is the group of nerves that leave the neck and travel down the arm. Pressure on the nerve complex while in the womb or stretching of the nerve during delivery can cause this problem. The entire upper extremity can be affected. Forceps delivery can also causes upper plexus lesions leading to a condition called Erb's Palsy. A child with this type of injury holds the arm and hand in a position called the waiter's tip deformity. The forearm is held next to the body and rotated with the wrist bent so much it looks like the child is asking for money or a tip. Recovery from a brachial plexus injury can occur with time. Physical and/or occupational therapy may be recommended. The therapist may place the child in a protective splint. The splint is meant to prevent permanent loss of joint motion. The child is encouraged to do exercises and activities to help maintain motion until recovery occurs. And finally, there is the isolated radial nerve palsy. Pressure on the radial nerve causes palsy of the wrist and hand (but not the shoulder or upper arm). This is rare and usually reported linked with long labors (more than 18 hours). Recovery is complete in all cases published in the medical journals.

James T. Monica, MD, et al. Radial Nerve Palsy in the Newborn. In Journal of Pediatric Orthopaedics. June 2008. vol. 28. No. 4. Pp. 460-462.

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