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Erb’s Palsy

Another common type of birth injury is Erb's palsy, which is also referred to as brachial plexus palsy. This condition is the result of an injury to the network of nerves called the brachial plexus. If an infant can move one arm but not the other, this may be a symptom of Erb's palsy. Approximately 1 or 2 babies in 1,000 suffer this type of birth injury, with about 1 in 10 of these cases requiring treatment. Fortunately, most infants with Erb's palsy will recover movement and sensation in the affected arm within the first five months.

Other names for this type of birth injury include:

• obstetric brachial plexus
• brachial plexus injury (BPI)
• brachial plexus palsy (BPP)
• brachial palsy in the neonate

Causes of Erb’s Palsy

The brachial plexus is a network of nerves that sends signals from the spine to the arm and hand to tell the muscles in the limbs to move. Although brachial plexus injuries can occur at any time, the most likely cause of Erb's palsy is the birthing process, particularly in difficult deliveries involving a large baby, a breech presentation, or a lengthy labor. In such cases, the delivering doctor may exert force to pull the baby from the birth canal. When the baby's shoulders pass through the birth canal, stretching on one side of the baby's neck may cause tearing or stretching of the brachial plexus nerves.

Four types of injuries to the brachial plexus can cause Erb's palsy:

• Avulsion is the most severe type of injury which causes Erb's palsy. Avulsion involves the nerve tearing from the spine. Surgery is the only treatment for avulsion injury.
• Rupture occurs when the nerve is torn, but not at the point where it attaches to the spine. This type of brachial plexus injury is another potential cause of brachial plexus injuries. Again, surgery offers the only hope for recovery in rupture injuries.
• Neuroma has also been named as a cause of Erb's palsy. In neuroma, the nerve has tried to heal itself, but scar tissue has grown around the injury, putting pressure on the injured nerve. The prognosis for recovery varies in infants with neuroma.
• Neurapraxia is a stretch injury, in which the nerve has been damaged but not torn. This type of brachial plexus injury is the most common, and most patients with neurapraxia recover on their own, with 90% to 100% functioning.

Symptoms of Erb’s Palsy

The symptoms of Erb's palsy are the same no matter which type of injury is the cause. Symptoms may include a limp or paralyzed arm, lack of muscle control in the arm, hand, or wrist, and lack of feeling or sensation in the arm or hand. Sometimes the arm may be bent at the wrist, with straight fingers. The severity of the Erb's palsy impacts its symptoms, treatment options and prognosis.

Erb's Palsy Treatment

Many cases of Erb's palsy will heal without treatment. However, if a child has not improved or recovered by three to four months of age, treatment options are available. Occupational and physical therapy will exercise the child's joints and muscles to keep them flexible, and therapists will teach parents how to help the child with exercises at home. If a child does not recover from a brachial plexus injury by five months old, surgery may be performed by a pediatric neurosurgeon to improve functioning. For maximum effectiveness, the surgery must be performed between the ages of five and twelve months; after the child reaches one year of age, surgery will not restore function.

Forms of Treatment for Erb’s Palsy May Include:

• Using daily PROM (Passive Range of Motion) exercises to increase joint flexibility and muscle tone
• Providing touch stimulation to the affected extremity using textured materials, koosh balls, vibration and massage to increase sensory awareness
• Using joint compression and weight bearing throughout the affected limb to increase — sensory receptor input/muscle contraction
• Active use of affected limb using a variety of activities which help increase strength and coordination
• Pool therapy

Finding Help for Erb’s Palsy

Children develop at different rates, and a delay in reaching one developmental marker or another should not be cause for alarm. However, if you observe muscle weakness or paralysis, or if your child is not developing the motors skills appropriate for his or her age, talk to your doctor. If, after examination and testing, the doctor makes a diagnosis of Erb's palsy, early intervention with appropriate treatments can make a big difference in your child's prognosis and quality of life.

What to Do if Your Child Has Erb’s Palsy

If your child is diagnosed with Erb's palsy or another brachial plexus injury, it is important for you take an active role in treatment. You can help your baby by doing the exercises recommended by your doctor or physical therapist. Doing these exercises with your baby several times a day, every day, beginning at about three weeks of age will help your child to maintain range of motion in the affected arm and prevent the joints from becoming permanently stiff.

As your child grows, focus on the child's abilities. Your support and encouragement will help your child to adjust to lingering limitations and develop positive self—esteem.

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If you think your child is suffering from a birth injury as a result of medical negligence, contact us.

The law limits the amount of time after a patient incurs an injury to file suit. The amount of time varies based on the theory of liability and the state in which the patient files the suit.