Physically palpate the intercostal spaces to locate the landmark of the apical pulse. Ask the female client to re-position her own breast tissue to auscultate the apical pulse. For example, the client gently shifts the breast laterally so that the apical pulse landmark is exposed.

The normal apex beat can be palpated in the precordium left 5th intercostal space, half-inch medial to the left midclavicular line and 3–4 inches left of left border of sternum. The apex beat may also be found at abnormal locations; in many cases of dextrocardia, the apex beat may be felt on the right side.

Rationale: The apical impulse is located in the fifth intercostal space at the midclavicular line.

The apex beat or apical impulse is the palpable cardiac impulse farthest away from the sternum and farthest down on the chest wall, usually caused by the LV and located near the midclavicular line (MCL) in the fifth intercostal space.

This is usually due to a thick chest wall, emphysema, pericardial infusion, shock or dextrocardia. Rolling the patient into the left lateral position may enable the apex beat to be palpated (Scott and MacInnes, 2006). The location and the character of the apex beat should be noted.

“Erb’s point” is the fifth point of auscultation for the heart exam, located in the third intercostal space close to the sternum. It has sometimes been attributed to famous German neurologist Wilhelm Heinrich Erb (1840 – 1921), but without historical evidence.

The aortic, pulmonic, tricuspid, and mitral valves are four of the five points of auscultation.

Erb’s point is the auscultation location for heart sounds and heart murmurs located at the third intercostal space and the left lower sternal border.

The murmur of aortic regurgitation is a soft, high-pitched, early diastolic decrescendo murmur usually heard best at the 3rd intercostal space on the left (Erb’s point) at end expiration with the patient sitting up and leaning forward.

The intensity of S1 depends upon: the position of the AV valves at the onset of ventricular systole, the structure of the leaflets themselves, and the rate of pressure rise in the ventricle. Normally, S1 is louder than S2 at the apex, and softer than S2 at the base of the heart.

Neurologically, the Erb’s point is a site at the upper trunk of the Brachial Plexus located 2-3cm above the clavicle. It’s formed by the union of the C5 and C6 roots which later converge. Affected nerves in Erb’s palsy are the axillary nerve, musculocutaneous, & suprascapular nerve.

Symptoms of this may include a burning sensation like an electric shock that passes down the arm, weakness or numbness in the arm, and paralysis, or pain. When the entire brachial plexus is injured, and not just the nerves involved in Erb’s palsy, the whole arm will be affected, including the wrist and hands.

How is Erb’s Palsy diagnosed? The diagnosis is based on the physical examination and certain tests. These tests usually include an EMG (to test the integrity of the nerve and muscle fibers) and an imaging study (MRI or CT – myelogram).

Erb’s palsy is initially frightening. The infant’s arm hangs limply from the shoulder with flexion of the wrist and fingers due to weakness of muscles innervated by cervical roots C5 and C6. Risk factors are macrosomia (large baby) and shoulder dystocia.

Erb’s palsy is a condition characterized by arm weakness and loss of motion. It can occur in both infants and adults. It’s typically caused by a physical injury during newborn delivery or by traumatic force downward on the upper arm and shoulder, damaging the brachial plexus.

One or two of every 1,000 babies have this condition. It is often caused when an infant’s neck is stretched to the side during a difficult delivery. Most infants with brachial plexus birth palsy will recover both movement and feeling in the affected arm, often with daily physical therapy exercises.

Is a Brachial Plexus Injury Such as Erb’s Palsy Considered a Disability? If your child has a brachial plexus birth injury (BPBI) such as Erb’s palsy, Klumpke’s palsy, or global palsy, they could be eligible for Supplemental Security Income (SSI), which is overseen by the Social Security Administration (SSA).

Most Infants Fully Recover from Erb’s Palsy The good news for parents of a baby born with this kind of injury is that it is most likely not permanent. The prognosis is generally positive, with the majority of infants recovering fully in just three to nine months.

Cerebral palsy is a term that covers a number of disorders that could impact a baby’s brain function and the movement of their body. On the other hand, Erb’s palsy, which is also known as brachial palsy, occurs when a baby suffers injury to the brachial plexus.