Broken collarbone and nerve damage in newborns. During delivery, the baby’s clavicle can break. Near the clavicle, there is an important nerve strand that controls the muscles in the arm. If the clavicle breaks, it can damage the nerve string, causing paralysis of the arm muscles. Depending on which part of the nerve cord is damaged. Let’s see Broken collarbone and nerve damage in newborns.
Broken collarbone symptoms
The broken collarbone A broken collarbone is usually not noticed by the parents. A doctor can detect it immediately after childbirth because the shape of the clavicle has changed. Sometimes there is a swelling at the fracture site.
Nerve damage After delivery, the child is always checked by the midwife or gynecologist. Severe paralysis can already be noticed. Lighter forms of nerve damage sometimes only become apparent later. During the care by the maternity nurse or during an examination by the consultation doctor, any nerve damage can be detected.
The Erb paresis In the Erb paresis, part of your child’s arm does not move properly. The arm lies loosely against the body and is moved less or not at all spontaneously. The arm can also become thinner after a few weeks than the healthy arm. This is partly caused by damage to the nerve supply to the muscles, partly by not using the muscles. In this paralysis, the upper arm is paralyzed, so that the shoulder and elbow do not move normally. The arm and hand are turned inwards, the elbow is straight. The wrist and hand can be moved normally.
Paresis of Dejerienne-Klumpke In the paralysis of Dejerienne-Klumpke, the forearm is paralyzed. The wrist and hand are not moved normally, while the upper arm can be moved normally. If severely damaged, the entire arm may be paralyzed.
How does a broken collarbone arise?
When the child is very large in proportion to the mother’s pelvis, problems can arise during delivery. It may happen that the head has already been born, but that the shoulders are still stuck. The child may experience breathing difficulties as a result. To prevent this, the body must be born quickly. Sometimes, therefore, the child has to be pulled strongly. This can put so much pressure on the collarbone that it breaks.
An important nerve bundle runs to the arm just below the collarbone. It contains the nerves that control the muscles of the arm. The broken collarbone can damage the nerve bundle, paralyzing the muscles. Incidentally, the nerve bundle can also be damaged without breaking the clavicle, especially during laborious and breech deliveries. When the upper part of the nerve bundle is damaged, it is called an Erb paresis or Erb-Duchenne paresis. When the lower part is damaged, this is referred to as a paresis according to Dejerienne-Klumpke.
Because the nerves, in addition to the muscles, also regulate the feel, temperature and blood flow of the arm, disorders can also occur here. The arm may feel deaf or cold to the child and the color of the arm may have changed.
Is it serious and what can you expect?
When an obstetrician or doctor detects a broken collarbone and paralysis, your child is referred to the hospital. Your child will then come to the pediatric neurologist or pediatrician for consultation. The doctor will examine your child and may have a muscle-nerve examination performed. This examination can determine where and how seriously the nerve bundle is damaged. You can also look for signs of nerve repair. This can have consequences for the treatment. The muscle nerve examination can be performed at the earliest six weeks after birth.
Broken collarbone If only the collarbone is broken, your child does not need treatment. A broken collarbone heals on its own. This can take several weeks and no casting is necessary. If no pressure is placed on the broken bone, there is little risk of damage to the nerve bundle. Incidentally, the location of the fracture can often be felt during a person’s entire life without this causing any complaints.
Paralysis If paralysis is found, it can also heal spontaneously, seven out of ten children are free of symptoms within six weeks. If there are still complaints after those six weeks, the recovery will take longer. Nerves recover slowly because new nerves have to be formed. This can take one to two years. During this period, you may encounter different types of health care providers.
Pediatric physiotherapist The help of the pediatric physiotherapist is often sought. This ensures that the joints, which your child cannot move, remain flexible. The joints should be prevented from stiffening. The pediatric physiotherapist also trains the muscles as far as possible.
Rehabilitation doctor The help of a rehabilitation doctor can also be called upon. He has a lot of experience in the treatment required for paralysis.
Brachial plexus team In the event of serious damage, your child is referred to a special team, the so-called brachial plexus team. Brachial plexus is the medical term for the nerve bundle in the shoulder, which controls the nerve supply to the arm. There are currently three of these teams working in the Netherlands, namely in Amsterdam, Leiden and Heerlen. The team, consisting of experienced doctors from different disciplines, can advise you well in making the often complicated choices for treatment.
Neurosurgeon Very rarely the damage is so serious that spontaneous recovery is not possible. An operation can offer a solution.
When to the doctor?
The midwife, gynecologist, maternity nurse and consultation doctor will all check whether your child’s arms move normally. If they find a paralysis, you will be referred to the doctor who will refer you to the hospital.
If you suspect that your child’s arm is not moving properly, you can discuss this with one of them or with your GP.
What can you do about it yourself?
It is not much you can do to heal the broken collarbone or paralysis. However, you can try to avoid new problems. Because the muscles are paralyzed, the shoulder can dislocate. There are a number of things you can do to prevent this.
Caring When caring for your child, it is important not to put too much pressure on the broken collarbone. The arm must remain as close as possible to the child’s body during care. You can do this by first putting the affected arm in the sleeves when dressing and when undressing, you then remove the affected arm from the clothes.
Lifting Do not lift your child under the armpits, but support it by the buttocks and shoulders. Never let the affected arm dangle down, but hold it against your child’s body. Preferably with the upper arm along the body and with the forearm in front of the body, just like in a sling (sling). Optionally, you can fix the arm in this position by attaching the sleeve of the clothing to the front with Velcro or a plaster. You can also make a sling from a large handkerchief.
Touch the arm a lot. The feeling in part of the arm may be absent so that your child is not aware of that arm. You stimulate it by touching it so that your child becomes aware of the arm. Touching the affected arm is important because the baby tends to move the arm more by the touch
Exercise After a few weeks, the muscles of the arm will be exercised by the pediatric physiotherapist. You will learn a number of exercises that you can do at home. In this way, the joints remain flexible and you train the muscles of the affected arm.
General advice and precautions
If you have had a child with a broken collarbone or paralysis before, report this to the midwife or gynecologist. This way they can take this into account and take precautionary measures.
If the midwife suspects that your child is large in relation to your pelvis, she will refer you to the hospital. There, an estimate will be made of the size of the child. If after this ultrasound there is still a suspicion that your child is too big for your pelvis, the delivery will take place in the hospital. If problems then arise, immediate action can be taken. If the child is extremely large, relative to the pelvis, then normal delivery is sometimes dispensed with. A cesarean section is then chosen.
Source: Dr. JH Schieving (author) Dr. HWJ Verblackt (consultant) Dr. WJ den Ouden (consultant)
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