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KMID : 0378019720150110123
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New Medical Journal
1972 Volume.15 No. 11 p.123 ~ p.128
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Obstetrical Palsy of the Brachial Plexus
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文亨南/Moon, Hyungnam
申延淳/鄭仁熙/Shin, Jung Soon/Chung, In Hee
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Abstract
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Four cases of obstetrical palsy of the brachial plexus were referred to the Electromyography(EMG) Laboratory of Severance Hospital between February and September, 1972. All four patients bad a history of normal gestation followed by difficult delivery due to large size at birth. In three of them the whole arm was involved(Erb-Duchenne-Klumpke palsy) and the fourth was classified as Erb´s palsy.
EMG examination made it possible to diagnose as injury of the brachial plexus proper. They are post-ganglionic lemons, since normal motor unit potentials are found in the rhomboid muscles and sensory nerve action potentials, are not evoked in the paralyzed extremity.
Treatment including application of hot packs to the involved upper extremity, followed by passive exercises to maintain the range of motion of all joints and electrical stimulation therapy was started immediately.
In the follow-up studies by EMG, it was possible to detect normal motor unit potentials in the muscles even though a muscle contraction could not be seen or palpated. As the muscle became reinnervated, the number of fibrillation potentials decreased gradually and the normal motor unit potentials appeared increasingly in number and amplitude.
In accordance with EMG and clinical findings, electrical stimulation therapy was discontinued and active assistive exercise started for the innervated muscles. Splinting was used only to prevent joint deformity due to muscle imbalance during the period of nerve regeneration. No joint contracture was observed in these cases. Therapeutic exercises are thought to be the most effective means of treatment.
Findings provided by EMG studies make accurate diagnosis and prognosis and indicate the course of nerve regeneration which permits appropriate selection of treatment procedures.
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