Chassaignac palsy

A Chassaignac palsy occurs primarily in young children up to four years of age. The so-called radial head in the elbow joint is dislocated. This is only possible for small children, as the radius head reaches its final size from the age of four. Basically, a distinction is made between Chassaignac paralysis and an elbow dislocation, whereby the transitions are mostly fluid for the layman.

What is Chassaignac Palsy?

The dislocation of the elbow joint is called an elbow dislocation. This is located between the humerus and the ulna. On the other hand, in the case of Chassaignac paralysis, one can only speak of a partial dislocation, in that the radius head jumps out of the ring ligament.

Both children and adults can be affected by an elbow dislocation. Chassaignac paralysis, on the other hand, is only possible in infancy.

causes

A Chassaignac paralysis is generally caused by a jerky pull.

In most cases, in which a Chassaignac palsy is triggered, the child concerned trips and the parents try to prevent it by holding the arm. This strong jolt can lead to a dislocation of the radius head.

Even if the child pulls back when they want to run ahead, it can sometimes cause such a big jolt that it can also lead to Chassaignac paralysis.

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Symptoms, ailments & signs

Chassaignac's palsy can lead to very unpleasant complaints, which in general have a very negative effect on the quality of life and on the everyday life of the person concerned. First and foremost, the Chassaignac paralysis leads to a gentle posture of the arm. This way, the joint is not stressed and pain is avoided.

When the joint is stressed, those affected suffer from severe pain and thus from restricted mobility. Since Chassaignac's palsy occurs in early childhood, the children's development is also considerably restricted. This prevents the affected children from playing properly or participating in other activities.

If the pain caused by Chassaignac paralysis also occurs at night, this can lead to severe psychological upsets or even to depression. Those affected also often suffer from swelling on the arm, which also reduces the aesthetics of the person concerned.

Chassaignac's paralysis also leads to paralysis or to various disorders of sensitivity in the affected person's elbow. Self-healing does not occur with this disease, so that those affected are dependent on medical treatment in any case. However, the paralysis does not have a negative effect on the life expectancy of the person affected and does not reduce it.

Diagnosis & course

The child will hold the affected arm still if they have Chassaignac palsy. In most cases, the arm is simply held down quietly. One can speak of holding the arm in a neutral position, so to speak.

The child's forearm and hand are held slightly inwards to protect the joint. This behavior is called pronation. The child will no longer move this arm and can also suffer from great pain.

Furthermore, there can be a swelling just above the radial head and a feeling of numbness, both in the hand and in the forearm.

Chassaignac paralysis is usually recognized immediately by the attending physician based on the appropriate posture and other symptoms and usually does not require any further diagnosis.

Complications

Chassaignac's paralysis is very painful and can be extremely stressful, especially for children. However, the pain only occurs at the beginning of the disease and then disappears again. The child's arm is paralyzed and can no longer be moved. In doing so, the child no longer turns or moves the forearm in particular, which creates severe restrictions in everyday life.

It is no longer possible for the patient to grasp or take certain things or to use their arms, for example, to play. Therefore, Chassaignac's palsy also prevents the child from developing. If the paralysis is not treated, it can be permanent and thus make the patient's everyday life very difficult. Even after successful treatment, there is a small risk that the paralysis will recur in the patient.

There are no further complications with the treatment itself. This can be done directly by the doctor with a special handle and relieves the patient of the symptom. If there is pain or other injuries to the arm, it can remain in a cast for a few days after the treatment. Pain can also occur after the treatment. There are no further complications.

When should you go to the doctor?

If you suspect Chassaignac palsy, you should definitely consult a doctor. Only a doctor can bring the dislocated radial head back to its starting position and thereby also resolve the symptoms. If you suddenly experience slight pain in the elbow area that cannot be traced back to any other cause, medical advice is required. Other warning signs that require clarification are symptoms of paralysis that appear to appear very suddenly and sometimes a slight reddening in the bend of the elbow.

Parents who notice symptoms in their child should make an appointment with the pediatrician immediately. Immediate treatment prevents symptoms from getting worse and usually provides rapid relief from symptoms. If the Chaissagnac's palsy remains untreated, however, further complications can arise and the symptoms will increase over time. Therefore: consult a doctor immediately if the child - especially small children up to the age of five are affected - suddenly no longer uses an arm or only uses it to a limited extent or complains of pain.

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Treatment & Therapy

The first step in treatment is usually an X-ray of the affected arm. This is intended to identify any fractures that may have been caused. However, this is not the rule with Chassaignac paralysis, but is carried out to be on the safe side if there are symptoms, for example after a serious fall.

Afterwards the doctor will try to adjust the radial head again. This happens very quickly, because a persistent crushing or overstretching of the neighboring nerves and blood vessels is to be prevented. Otherwise there could be unpleasant consequential damage.

Before the contraction occurs, the affected child is usually injected with a painkiller and sedative. This is to prevent the child from tensing his muscles and making it difficult to straighten out. This step usually goes off without any problems and the child can then move his arm as usual.

After the reduction, however, the arm is usually examined again. The attending physician pays particular attention to the fact that the elbow joint is sufficiently stable. Because when the radial head pops out, joint ligaments and joint capsules can be damaged or occasionally completely torn. This allows the radial head to pop out again quickly. Furthermore, the doctor will clarify whether there are sensory disorders in the arm and whether they are not going away. If this is the case, this can indicate an injury to a main artery. It could also have damaged the nerves.

If severe instability has been identified, operative action must be taken to prevent permanent damage. To be on the safe side, the affected child is usually put on a plaster splint for about two to three weeks to prevent them from jumping out again. Physiotherapy can also be ordered if the ability to move cannot be restored on its own.

However, this is usually only necessary in very severe cases. In the event of a dislocation caused by a "normal" jerk, the child can move the arm without problems after the dislocation and no longer has any pain. Even the prior injection of painkillers and sedatives is often essential.

Outlook & forecast

In most cases, Chassaignac palsy does not cause permanent or protracted damage. This is especially the case if the injury is checked immediately by a doctor who can straighten the head again. This does not damage any nerves, so there are no further complaints. The child can move the arm without restrictions after the straightening.

As a rule, however, a few examinations are still necessary after the adjustment to detect further damage. In the event of instability, this can be treated with a surgical procedure and subsequent physiotherapy. As a rule, mobility is not negatively affected and can be completely restored. Surgical interventions are rarely necessary and in severe cases in the event of severe injuries.

The reduction itself can be painful, but afterwards there is no pain when moving. In most cases, Chassaignac's palsy can be completely treated with it, resulting in a positive outcome.Complications can only arise with delayed treatment.

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prevention

Care should therefore be taken not to pull your child too hard by the arm to prevent Chassaignac paralysis.

Aftercare

In the case of Chassaignac palsy, the follow-up measures are usually severely limited or are not available to the person affected. The disease must first and foremost be recognized early and treated by a doctor so that this paralysis does not persist and there are no further complications or complaints. The earlier Chassaignac's palsy is recognized and treated, the better the further course of this disease is usually.

In general, the activity that led to Chassaignac's palsy should be avoided. After the accident, the affected area should be immobilized and no longer stressed. The patient should avoid strenuous or physical activities in order not to unnecessarily stress the body. In some cases, this disease also requires physical therapy, whereby the affected person can also perform some of the exercises at home and thus speed up healing.

Since the disease usually occurs in young children, parents should always support the children in the treatment and encourage them well. If the pain is severe, pain medication should be given, although it should not be taken for a long period of time. After the treatment, regular checkups by a doctor are very useful.

You can do that yourself

Chassaignac's palsy is a partial dislocation of the elbow in which the radial head jumps out of the ring ligament. This disorder can only occur in small children, as the radial head usually reaches its final size during the fourth year of life. In the case of Chassaignac paralysis, the parents or caregivers of a toddler need to act quickly. If the injury is not recognized or not treated promptly, the paralysis can become permanent or be accompanied by severe long-term consequences.

Chassaignac palsy usually causes severe pain at the beginning. Parents should always take such complaints very seriously and consult a doctor, even if no serious injury seems to have preceded. Chassaignac paralysis usually occurs as a result of jerky movements. This can be the case when children pull each other by the arm while playing or when parents can barely hold a falling child by the arm. Often the trigger for the disorder is completely unspectacular.

It becomes dangerous when the children are not in acute pain and the dislocation is therefore not recognized immediately. Parents should therefore always react promptly to certain behaviors. Even if children do not suffer from pain, they usually cannot move the arm affected by Chassaignac's palsy or try to spare it. Parents who observe such behavior should seek medical advice immediately, even if the child does not complain of any symptoms.