Thus, a large fetus weighing buy atomoxetine is much more at risk of developing this pathology. With breech presentation, there is a high risk of injury or rupture of the sternocleidomastoid muscle, which also plays a role in the pathogenesis of paralysis.
Paralysis of Dejerine-Klumpke (lower) affects the lower bundle of the brachial plexus or the roots of the spinal cord from the last cervical vertebra and below. Total obstetric paralysis affects the entire bundle and is the most severe form of paresis. In addition, there are combined lesions of the bundles of varying degrees and atypical paresis, in which both sides are involved.
The division is carried out on the basis of atomoxetine of the injury in the nerve plexus. Allocate upper, lower and total paralysis. Upper obstetric Duchenne-Erb palsy) develops when the upper primary bundle of the brachial plexus or the upper roots of the spinal cord, corresponding to the first six cervical vertebrae, are damaged.
Symptoms of obstetric paralysis. As a rule, such paralysis is noticeable from birth, except for mild cases, which are detected as the level of conscious activity of the child increases, that is, by 3-6 months. But more often, a pediatrician and a pediatric neurologist, already at the first examination, diagnose reduced muscle tone and a change in sensitivity. The arm hangs, there are no Moro and Robinson reflexes, as well as a palmar-mouth reflex.
Depending on the localization of obstetric paralysis, muscle tone and sensitivity are more reduced either in the proximal part of the arm (shoulder joint, shoulder) or distally (forearm and hand). At the same time, motor activity can be observed in the zone of innervation of intact nerves, although to a lesser extent than on the healthy side.
Sensitivity in the damaged limb is reduced, however, it is possible to determine hypesthesia in newborns only if it is sufficiently pronounced. The child either does not experience pain when tapping with a hammer, or hyperesthesia is noted at the slightest physical contact with the paralysis area. The limb remains cold to the touch.
With obstetric paralysis, cerebral symptoms can be observed in the form of agitation, tremor, and inhibition of unconditioned reflexes. These are signs of hypoxia. Usually they are present for a short time and pass on their own. One of Strattera complications of obstetric paralysis is muscle contractures and bone deformities that develop after them as a result of the pathological position of the limb.
In most cases, the diagnosis is not difficult. It is possible to suspect obstetric paralysis on the basis of the course of labor, the fact of hypoxia and the results of the examination. The level of paralysis is confirmed by electromyography of the child. First, the study makes it possible to differentiate primary muscular pathologies from injuries associated with the nervous system.
On radiographs of the cervical spine, a gross posterior displacement of the C3-C4 vertebrae is detected. The nucleus of ossification in the left shoulder joint is smaller. According to EMG data, there is complete bioelectrical silence in the muscles of the left hand (type IV).
The following observation can serve as an example of obstetric paralysis of the hand of the Erb-Duchen type. Child P., 1 month old, was admitted to the clinic due to the lack of movements in the left arm. The disease was noticed immediately after childbirth. Was born from V pregnancy, IV childbirth, at term with a weight of 5000 g using a vacuum extractor, in blue asphyxia.
The frequency of predominant lesions of the C5-C6 segments in obstetric paralysis is also easily explained from the point of view of the possible role of natal injury of the cervical spine and spinal cord, since it has been proven that the greatest load during the birth of the fetus falls precisely on the C5-C6 segments of the spinal cord.
First of all, the deltoid, biceps muscles suffer. This type of lesion is much more common than the others, which the authors explain by the special proximity of the upper primary bundle of the brachial plexus to the supraclavicular fossa (Erb's point) - the place of supposed pressure on the plexus during childbirth.
As mentioned, most authors divide all cases of obstetric paralysis into three types. The first type - Erb-Duchene's palsy - is associated with a lesion of the upper primary bundle of the brachial plexus (segments C5-C6) and consists in the predominantly proximal localization of paralysis of the muscles of the arm.
Children with obstetric paralysis are treated very rarely on a stationary basis and, if treated, then most often in orthopedic clinics. Oddly enough, such patients are least often observed by pediatric neuropathologists. As a result, there is no continuity in the interpretation of neurological symptoms, many subtle neurological signs fall out of sight, and relatively mild cases of obstetric paralysis are sometimes completely overlooked.
The clinical picture of obstetric paralysis of the hand, both in the neonatal period and at an older age, is considered so characteristic that it is hardly possible to confuse it with other diseases. But, unfortunately, the descriptions of this clinical symptom complex available in the literature belong to specialists in various fields: some doctors examine and treat these children in the maternity hospital, others monitor them in subsequent years.
Symptoms of obstetric paralysis in infants.
Total obstetric paralysis is amenable to only minor correction and requires long-term therapy for many years. Muscle tone, sensitivity and strength are not fully restored. If treatment was started late, muscle contractures may form, significantly worsening the prognosis for cure. In addition, muscle contractura subsequently lead to bone deformities. As a result, underdevelopment, atrophy is noticeable on the affected side, osteoporosis is confirmed radiologically. Prevention of obstetric paralysis is possible only with proper management of childbirth.
Also used electrophoresis with anticholinesterase drugs and antispasmodics, tropic to the vessels of the brain and spinal cord. In systemic drug therapy, cholinesterase inhibitors and B vitamins are used. External use of absorbable enzyme preparations is shown.