Peripheral nerve injuries/palsies (Children)
🧾 Introduction
Peripheral nerve injuries and palsies in children can result from a range of causes including trauma, congenital abnormalities, and perinatal injury.
They may present with motor and sensory deficits that affect growth, development, and function.
Early recognition and prompt rehabilitation are essential to reduce long-term disability.
⚡ Aetiology
- 👶 Birth Trauma: Brachial plexus injury during shoulder dystocia → Erb’s palsy, Klumpke’s palsy.
- 🤕 Trauma: Falls, sports injuries, fractures causing nerve compression or transection.
- 🧬 Congenital Conditions: Muscular dystrophies, hereditary motor sensory neuropathies.
- 🦠 Infections & Immune-mediated: Guillain–Barré syndrome, viral neuritis (e.g. VZV).
- 🎗️ Tumours/Cysts: Nerve compression (neurofibromas, ganglion cysts).
🩺 Clinical Features
- 💪 Muscle weakness or paralysis (depends on affected nerve).
- 🖐️ Loss of sensation in nerve distribution.
- 📉 Atrophy/wasting in chronic lesions.
- 😖 Pain (less common in infants, more in older children/trauma).
- ⚖️ Abnormal reflexes (diminished/absent).
📌 Types of Peripheral Nerve Palsies
- 🖐️ Erb’s Palsy (C5–C6): “Waiter’s tip” arm posture – adducted, internally rotated shoulder, extended elbow, pronated forearm.
- 🤲 Klumpke’s Palsy (C8–T1): “Claw hand” due to intrinsic hand muscle weakness; may be associated with Horner’s syndrome (ptosis, miosis, anhidrosis).
- ✋ Radial Nerve Palsy: Wrist drop; inability to extend wrist/fingers.
- 🦶 Peroneal Nerve Palsy: Foot drop → difficulty dorsiflexing ankle; high-stepping gait.
- 🙂 Facial Nerve Palsy: Facial droop, loss of forehead wrinkling, poor eye closure.
🔎 Diagnosis
- 👩⚕️ Clinical exam: Assess power, tone, reflexes, sensation.
- ⚡ Electromyography (EMG): Detects denervation, recovery potential.
- 📈 Nerve conduction studies: Assesses conduction velocity/block.
- 🖼️ Imaging (MRI/US): Defines compressive lesions, structural anomalies.
💊 Management
- 🏋️ Physiotherapy: Prevents contractures, maintains ROM, improves strength.
- ✋ Occupational therapy: Improves hand/wrist function (e.g. in Klumpke’s palsy).
- 🔪 Surgery: Nerve grafts, transfers, tendon transfers in severe/irreversible palsy.
- 🩹 Bracing: Splints for foot drop or hand weakness.
- 💊 Pain control: Analgesics/anti-inflammatories if needed.
📊 Key Examples Table
| Palsy | Nerves/Roots | Classic Clinical Sign |
|---|
| 🖐️ Erb’s | C5–C6 (Upper plexus) | “Waiter’s tip” arm posture |
| 🤲 Klumpke’s | C8–T1 (Lower plexus) | “Claw hand” ± Horner’s syndrome |
| ✋ Radial nerve | Posterior cord | Wrist drop |
| 🦶 Peroneal nerve | L4–S2 | Foot drop |
| 🙂 Facial nerve | CN VII | Facial droop, weak eye closure |
📈 Prognosis
- Many birth-related brachial plexus injuries recover with physiotherapy within months.
- Severe lesions (avulsion or root rupture) often leave persistent deficits.
- Earlier intervention (surgery <6 months in Erb’s palsy) → better outcome.
🛡️ Prevention
- 👩🍼 Skilled delivery techniques → reduce brachial plexus injury risk in shoulder dystocia.
- ⚽ Protective gear in sports → prevent traumatic nerve injuries.
- 🧬 Genetic counselling for congenital neuropathies.
