Is this Erb's Palsy?

[fnm]

Sorry for the long post.
I posted a thread on here back in Jan and we have now been referred to a consultant pedeatric nurologist at a childrens hospital for futher investigation.
Basically DS who is now 14 months is having problems with his right arm, he can move his arm, lift it up, can clap but his fine motor skills are practically none existant. If he is doing building blocks he will use his left hand for all of it, only using his right to kind of support the blocks but thats about it. Whilst doing all other activites he doesnt use it, whilst eating its as if he doesnt 'know' its there. After some advice from another mumsnetter (Hecatequeenofghosts thank you) i have been doing a little research. On our last appointment with the consultant orthopeadic (at the same hospital where DS was born)he said it wasnt muscle or bone its more likley to be pressure on his brain during birth or nerve problems or damage and pointed to the neck/shoulder area. I immediatly asked if it could be erbs palsy and he said unlikley as erbs points there arms inwards, didnt say yes or no and then kind of dismissed it. But we will see what these futher tests bring back once we get the appointment through.
My question is though, is nerve damage in the neck/shoulder area the same thing as erbs palsy or could it be something else?

Erbs can be caused by excessive pulling on the shoulders during a normal vertex delivery.
This may help:
en.wikipedia.org/wiki/Erb%27s_Palsy
You may have seen this before, if so, sorry.

I cant recall ds being pulled but i was out of it, he was in areally awkward postion, back to back, slightly to the side with his head tucked in. i am wondering if this position could have caused some damage of if he was 'pulled' but i wasnt aware of it. they certainly didnt mention any 'difficultys' after the birth and my impression was that all went ok.
Guess we will ahve to see what the nurologist says.
Is there another condition known from nerve damage during birth?

Shoulder dystocia during labour/birth can lead to Erb's palsy - did your ds get stuck during his birth?

Lots of information here:

www.erbs-palsy.co.uk/

Hope you get some answers soon.

The paed originally thought my dd has Erb's palsy but in fact on further investigation was found to have mild cerebral palsy. Does your ds do everything else you might expect from a 14 month old? are there any other delays? Obviously I can't begin to specualate as am not medically trained and of course have never met your ds but it might be worth mentioning to the paed. Best wishes.

As far as i am aware the midwife never said he was stuck but i do remember her saying he was in a really awkward position so i must try and push V.v hard!!! I am wondering if its worth getting a copy of his birth notes, just to see what they have put.
So far he seems to be meeting all his milestones, he cant walk yet but is cruising, he crawled at 11 months although with his left leg tucked in, however we also have a 2yr old dd and ds never seems as sturdy as her, and dribbles nearly all the time (today i must have gone through 5 bibs and 3 top changes) i have put it down to teething, but even when he isnt teething he still dribbles!!! C.P has crossed my mind before but i guess we need to look into it futher.

I think it sounds as if your ds is doing really well but I would ask about CP, especially with the leg tucked in. I know it sounds scary but it would be good to rule it in or out as at least then your ds would be getting appropriate treatment. I know there's a lot to take on board but if you have a chance, have a look at the Bowen Technique. It's an amazing therapy that is great for all children and I'm sure that whatever the cause or diagnosis, could help your ds.

Thanks for that bellyofbabylon. I have been reading up a little on mild cp and some of it does make sense, i can certainly relate to some of it. Its a bit scary but id rather prepare myself for the worst so whatever they come back with its not too much of a shock.
Can i ask how old your dd is and how you came about noticing the differnces. I know all children are different but how has it affected your child?

not ignoring you fnm - will be back later once have sorted out bedtime for the dd's

Hi fnm - my dd was 3 last week. She was 5 weeks early so when she was late sitting up and stuff everyone told us she was just catching up as she was a bit premature. I remember we noticed at about 7 months that she was really only using her left hand and I knew that handedness should not be evident at such a young age. Her right hand was most often in a little fist as well and she used to carry around an object like a little play person in her right hand for sometimes hours at time as she could pick something up but not let it go! I spoke the health visitor who again fobbed me off, but kept fussing till they referred us to the community paediatrician when she was a year old. She examined Heather and said she was 99.9% sure that it wasn't cerebral palsy (as I suspected) but thought it was a shoulder problem and probably Erb's Palsy. She referred us on the child development centre at the hospital where they examined her further and started talking about her 'conditon' - finally after about half an hour I said 'what exactly is this condition?' - they said mild cerebral palsy and I was kind of 'phew' at last we have a name.

Not pretending I wasn't devasted and that sometimes life is hard but cerebral palsy affects so many children in so many different ways - as it turns out my dd is more affected than they thought at first (thought it was one side only but now it's both legs and one arm) but on the upside she is bright as a button and has excellent speech. Life could be a lot worse frankly and there is so much you can do with mild cerebral palsy - things like conductive education and bowen technique.

where are you at with it all now? are you seeing a paediatrician again? I know there are lots of reasons for your ds's symptoms so it doesn't have to be CP but if it does turn out to be that there are loads of us here for support.

Hi Hangingbellyofbabylon, thank you for letting me know your experiences and thank you for the support.
Blimey, the more i read the more i can relate to it. Can i ask if it was a difficult birth and if that has had any impact on your DD's CP? How is your daughter now, does she find other ways/her own way to get about with daily tasks? now its in both legs can she walk ok and was you aware it could be in her legs before they told you?
DS is cruising about, can bear his weight on both legs and is fave activity at the moment is climing the stairs . However when crawling its his left leg that gets stuck under and he kind of uses it to paddle himself along, although a lot of mums at mums and tots have said their children crawled like that so im not too sure what to make from it. Regards to his right hand, well, somethings he tries and uses it for but his thumb kind of gets tucked in and he often hold it in a tight fist whilst doing things especially eating.
At the moment the consultant orthopeadic has referred ds to a consultant peadiatric nurologist (we are waiting for the referral to come through, but he was only seen by the orth 2 wks ago) he said they will examin him and if they need to do any scans ds will have to be put to sleep , but as long as we get to know exactly what it is and what steps we need to take i guess it will be necessary.
Thanks again.

Yes dd did have a difficult birth - she stopped moving at 35 weeks and was delivered by emergency c-section. I've been told that the placenta was withered so there must have been a problem there. She was actually in pretty good condition when she was born and didn't need to go into special care or anything. I know the idea of scans are really scary - my girly had an mri about a year ago and they said she might need a general but in fact she ended up with just sedation. I flapped and flapped but in the end it was all much better than expected.

My dd walks with a frame at the moment but that is because both legs are affected. I know loads of children with one leg and one arm affected who are now walking really well and tbh if your ds is cruising and climbing the stairs he's already doing really really well. From the children I've met, most who have hemiplegia (one side affected) walk between 2-3 years and those with diplegia (both legs like my dd) walk between 3-5 although that is very general. We didn't expect legs involved at all at first as dd was moving at all at a year and had only just learnt to sit up - it the mri that really helped with the diagnosis.

We go to a parent and child group at the Rainbow centre once a week - it's a lovely place and has made a massive difference to us all. It's also great as you meet other parents and other children so you get a better idea about how other children are affected. I hope you get that appointment through soon, it's frustrating waiting I know.

Thank you so much for letting me know your experiences, sounds like you have a lovely little girl and i hope everything goes well for you all.
I know its only very early days yet with my DS but from what i can gather it could quite possibly be mild cp as its as if his brain just doesnt send the signals to his hand to do most tasks but we will have to wait for the referral.
We last saw the orthopeadic 2 wks ago, he said he will send me a copy of the referral letter he sends out to the nurologist, so far havnt received anything but i know these things take time.
I will keep this post updated when i get any new info.
Many thanks again.

hi again. neck / shoulder (nerve?) injury is erbs palsy, yes.erbs palsy group

If you still think it might be erbs, you really need them to get the electrical tests done, to check how the nerves are functioning.

Keep pushing them. You need to know what you are dealing with, cp, erbs, whatever it is, in order to access most appropriate help for your son.

They take their sweet time and you have to be a right royal pain in the arse to get them to pull their fingers out

Hello again hecate, thanks for that. As you have prob read, the original hospital have now referred us so hopefully the next hospital will be more helpfull and be able to provide us with more answers.
On reading into things it sounds like erbs or cp, but can i ask, from your knowledge, can someone with erbs use the affected arm/hand for certain tasks but not for others? for example DS can use it for clapping and to support himself when pulling up but most other times he holds it in a tight fist and 'forgets' its there. We have tried to hold back his good arm with hope he will use his affected arm but he just gets frustrated.

yes. depends which nerves have been affected. depends on severity of injury.

My son's arm was 100% paralysed at birth but over the years (and op!) has recovered some function. his fine motor skills are good.

Where he struggles is lifting his arm above his head, and straight out in front or to the side of him, he couldn't lift something heavy off a high shelf, or out of the oven for example, but he can thread tiny beads

Every injury is different.

my son tended to hold his hand in what they call a "waiters tip" like this in fact, that's pretty much what his arm was like at first.

Later, when he recovered some movement, it was forward, bent at the elbow and rounded into his body from the shoulder.

When we last saw the orthopeadic he said it could be nerve damage and pionted to the brachial plexus area on his own neck, immediatly i questioned him and asked if it could be erbs but he said prob not as erbs sufferers tend to hold their arm in the waiters tip which you describe, and my son doesnt nor has he ever done. sorry to sound stupid but if it is nerve damage in that area can it also be known as something else apart from erbs or does it all lead to erbs but different severity?
Although he is only 14 months he cant lift heavy objects with his arm (but then dont think he has ever tried) and he certainly couldnt pick up little items such as beads, meal times are v.messy , uses his good hand to eat, with or without fork/spoon can pick up tiny peas ect all with his affected arm just there at his side in a fist

Hecate - don't want to sound like a broken record but have you heard of the Bowen Technique? I have just finished training and regularly treat dd. I am certain that Erb's Palsy is a condition which Bowen could help. We have some really good moves that help with neck and shoulder restriction in particular. It's hard to describe but it is very gentle and suitable for all ages. more info here if you're interested: www.bowen-technique.co.uk/

no, I haven't, but having a look I am thinking if I could get a 9 yr old boy with autism to sit still for an hour while someone strokes and pokes him, I'd get a mention in the new years honours list!

however, it looks so relaxing that I'm wondering if I could have some myself

Is it always an hour, or is there anything you could do in five minutes or so? (that's about the size of your 'touching' window, iyswim )

I was thinking about the touch thing as well, the good thing is that children's sessions are normally much shorter and also can be done with the child seated or even playing on the floor really, whatever they feel happiest with. When I take my dd's for Bowen they often end up under the table with the therapist crawling around after them. It's a shame you're not nearer me as I'd happily have a go. Lots of people either don't charge for children or just ask for a token donation as well which helps. It would be good for you as well I'm sure, I always try to treat the mums as well as the children as we often bear the brunt of it really.

Just an update really, we are still waiting for the referal appointmet to come through to see the nurologist however in the meantime more things are coming to light!!

DS is now standing more are trying to walk (he has take a couple of steps so far, yayyy!!!) however now he is spending more time stood up it now appears his right leg is looking more like his right hand, as in his toes seem clenched and he is leaning on his foot a little to the side, its not as 'normal' as his left foot,

Just hope the appontment comes through soon, how long do you usually have to wait for these things to come through?

Hi fnm, must be so frustrating waiting for the appointment. It varies from hospital to hospital but in my experience it helps if you keep ringing up and asking and also offer yourself for any cancellations if you can. Sounds like your ds is doing really well, those steps must have been magical.

Have you had a look at the Hemihelp website? May be totally off the mark but from what you describe your ds sounds similar to the little ones I know who have very mild hemiplegia.

Hello again HBOB, thanks for that info, i might start chasing it up soon if we dont hear by the end of the week.

Nope, i dont think you are totally of the mark at all, infact i had a look at the website (never seen it before) it could quite be a possibility. when i get some time to myself this evening i will look into it a little more, i know looking into these things is scary ( more for DH than me, he feels i ma looking into it a little too much) but i would rather be prepared for whatver is to come than not know anything about anything.

Thanks again.

hi fnm, weirdly it was someone here who pointed me in the direction of hemihelp and it was like a lightbulb moment, I remember reading it and thinking dd ticked all the boxes. It did mean I was prepared for the diagnosis but I know what you mean, it is scary and nothing in life prepares you for that possibility.

I'd be tempted to look at conductive education near to you because even without a diagnosis they'd be able to give you some good pointers of how to help.

Sorry for sounding ignorant but what is conductive education, this is all very new to me.

I have had a little look into things today and it really is something that could be a big possibility, today we was playing with a balloon and whilst he was stood up (with me holding his hands) he would only kick the balloon with his left leg, even when it was right in front of his right leg, he moved his body so his left would kick it. So i think it now shows in his leg foot as well as his hand. Oh this is scary!!!

How do drs diagnose hemiplegia/cp? do they do tests, can they just tell? do all children get offered mri/ct scans?