Brachial Plexus Palsy

The renowned British obstetrician Smellie is credited with the first medical description of an obstetric brachial plexus palsy. In his 1768 treatise on midwifery, he reported a case of transient bilateral arm paralysis in a newborn after difficult labour with a face presentation. In 1861, Duchenne coined the term “obstetric palsy of the brachial plexus” after analyzing 4 infants with paralysis of identical muscles in the arm and shoulder. In 1875, Erb concluded in his thesis on adult brachial plexus injuries that associated palsies of the deltoid, biceps, and subscapularis are derived from a radicular lesion at the level of C5 and C6 rather than isolated peripheral nerve lesions. In the same year, Klumpke described lesions of C8 and thoracic nerve T1 in birth palsy and associated the Horner sign with lower trunk lesions of the brachial plexus. Perhaps the most famous case of brachial plexus palsy was that of Prince William of Germany, who subsequently became Kaiser Wilhelm II in 1888. Apparently, William was in breech presentation and manipulated by several physicians and a midwife during delivery. Three days after delivery, the midwife noticed that William's left arm was slack. For the rest of his life, William's withered left arm was concealed from the public by careful posing for photographs.