Erb’s Palsy

Fact-Checked and Medically Reviewed by:
Beth Carter Registered Nurse, Legal Nurse Consultant Certified
Quick Answer

Erb’s palsy is a type of birth injury caused by nerve damage in the shoulder, arm, and/or hand. Over 80% of children with Erb’s palsy will make a full recovery with treatment, but health care expenses can add up quickly. If your child’s Erb’s palsy was caused by a medical mistake during the delivery process, your family may qualify for financial assistance.

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What Is Erb’s Palsy?

Baby being fed

1 out of 1,000 babies are born with Erb's palsy

Source: American Academy of Orthopedic Surgeons (AAOS)

Erb’s palsy, also called brachial plexus birth palsy or Erb-Duchenne palsy, is a condition caused by nerve damage during the birthing process.

The brachial plexus is a network of nerves that send signals from the spine to the shoulders, arms, and hands. Erb’s palsy can develop if these nerves are pulled or stretched too hard.

 

Types of Erb’s Palsy Injuries

There are several types of Erb’s palsy injuries. The type of brachial plexus injury a child develops can depend on the severity of damage to the nerve network.

The four types of nerve injuries are:

NeuropraxiaNeuropraxia

This is the most common type of Erb’s palsy. In this type, the nerves are stretched but not torn, causing a stinging or burning sensation. Neuropraxias generally heal on their own in three months or less.

NeuromaNeuroma

More severe than neuropraxias, neuromas occur when scar tissue develops as nerves heal from an initial tear. This places pressure on healthy nerves. Most children with neuromas will only partially recover.

RuptureRupture

This injury occurs when the nerve is torn. This type of injury does not heal on its own and generally requires nerve graft surgery to put damaged nerves back together.

AvulsionAvulsion

This is the most severe brachial plexus injury and occurs when the nerve roots are completely torn from the spinal cord, resulting in permanent muscle weakness/paralysis. Surgery can help repair torn nerves, but cannot reattach them to the spinal cord.

Causes of Erb’s Palsy

Illustration of a baby with nerve damage on the left side of its neck and shoulder.One of the most common causes of Erb’s palsy is a condition called shoulder dystocia, which occurs when an infant’s shoulder is caught behind the mother’s pubic bone during childbirth.

When a medical professional pulls on the baby to release their shoulder, it can stretch or tear the healthy nerves of the brachial plexus.

Other situations that may cause Erb’s palsy include:

  • Pulling the baby’s head or neck sideways as they pass through the birth canal during a difficult delivery
  • Pulling the baby’s shoulders during a head-first delivery
  • Pulling on the baby’s feet during a feet-first (breech) delivery, putting too much pressure on the infant’s arms
  • Shoulder dislocation or fractures in the collarbone (clavicle)

All of the actions listed above may be considered medical negligence. Doctors, nurses, and other medical professionals who use too much force during delivery can cause preventable cases of Erb’s palsy.

There are also a few risk factors that may increase the odds of a child developing a brachial plexus nerve injury during delivery.

Risk factors leading to Erb’s palsy include:

  • Abnormal maternal pelvis shape
  • Birth weight over 8 pounds, 13 ounces (macrosomia)
  • C-section (cesarean section)
  • Maternal diabetes
  • Maternal obesity
  • Second stage of labor lasting longer than one hour
  • Use of forceps or vacuum delivery

Talk to one of our caring registered nurses today to learn if your child’s injury was caused by medical negligence.

Nurse Beth Carter

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Other Types of Brachial Plexus Injuries

There are other types of brachial plexus injuries besides Erb’s palsy. These injuries are much rarer than Erb’s palsy, but present similar symptoms and respond to the same treatments.

Other types of brachial plexus injuries include:

  • Klumpke’s Palsy: This type of injury involves nerve damage in the lower arm and affects mobility in the hand and wrist.
  • Total Brachial Plexus Palsy: This condition involves nerve damage in both the lower and upper arm and causes complete paralysis in the affected limb.

Since these conditions have similar signs as Erb’s palsy, it is important to get a proper diagnosis from a doctor in order to get the best treatment.

Erb’s Palsy Symptoms

An adult hand touches a baby's right shoulder.There are several common symptoms that may mean a child has developed Erb’s palsy. These Erb’s palsy symptoms can vary depending on how damaged the brachial plexus nerves are.

Notable signs of Erb’s palsy include:

  • Limited ability to grasp objects or only using one hand to grasp
  • Limited muscular or nerve development in the arm or hand
  • Limp arm, wrist, or hand
  • Muscle weakness in one arm
  • Numbness or tingling in shoulder, arm, or hand
  • Partial or complete paralysis of the arm

If you had a difficult childbirth and your baby is experiencing any of the symptoms listed above, they may have developed preventable Erb’s palsy.

Diagnosis of Erb’s Palsy

If you suspect your child has Erb’s palsy, you should consult your doctor or pediatrician. Only a medical expert can accurately make an Erb’s palsy diagnosis.

A doctor will conduct several examinations and imaging tests to diagnose brachial plexus palsy.

Common Erb’s palsy assessment tests include:

  • CT (computed tomography) scan: This scan takes images from several angles of the body to search for damage to soft tissues, such as the brachial plexus.
  • MRI (magnetic resonance imaging) scan: This scan takes images of the internal tissues in the body to look for brachial plexus nerve damage.
  • Nerve conduction study: This physical test finds how quickly the electrical impulses from electrodes travel through the brachial plexus nerves.
  • Physical examination: Doctors will look for any physical signs of nerve damage, such as muscle weakness and limited mobility of the arm, shoulder, wrist, or hand.

Your child’s doctor may use a combination of these diagnostic tests to determine an accurate diagnosis.

Preparing for the Doctor’s Appointment

When prepping for your child’s doctor’s appointment, it’s important to note their symptoms and how long they have been present. Early detection and treatment are the keys to fully recovering from Erb’s palsy.

IS YOUR CHILD MISSING DEVELOPMENTAL MILESTONES?

Take Our Milestones Quiz

Taking note of your child’s physical, social, and emotional skills can help you determine if they potentially suffered from an injury at birth. An early diagnosis can help your child get the treatment they need as soon as possible.

Q1: How old is your child?

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0-2 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child hold their head steadily on their own?
  • Q3: Can your child push themselves up when they are lying on their stomach?
  • Q4: Has your child started to make smoother movements with their arms and legs?
  • Q5: Does your child smile at other people?
  • Q6: Can your child bring their hands to their mouth?
  • Q7: Does your child turn their head when they hear a noise?
  • Q8: Does your child coo or make gurgling noises?
  • Q9: Does your child follow things with their eyes?
  • Q10: Does your child try to look at their parents or caregivers?
  • Q11: Does your child show boredom, cry, or fuss when engaged in an activity that hasn’t changed in a while?
BACKBACK0-2-years old child

3-4 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child hold their head steadily on their own?
  • Q3: Does your child push down on their legs when their feet are on a flat surface?
  • Q4: Has your child started to roll over from their stomach to their back?
  • Q5: Can your child hold and shake a toy such as a rattle?
  • Q6: Does your child bring their hands to their mouth?
  • Q7: Does your child play with people and start to cry when the playing stops?
  • Q8: Does your child smile spontaneously, especially at people?
  • Q9: Does your child copy some movements and facial expressions of other people?
  • Q10: Does your child babble with expressions and copy sounds they hear?
  • Q11: Does your child cry in different ways to show hunger, pain, or tiredness?
  • Q12: Does your child respond to affection like hugging or kissing?
  • Q13: Does your child follow moving things with their eyes from side to side?
  • Q14: Does your child recognize familiar people at a distance?
BACKBACK3-4-years old child

5-6 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child roll over on both sides (front to back/back to front)?
  • Q3: Has your child begun to sit without support?
  • Q4: Does your child rock back and forth?
  • Q5: Can your child support their weight on their legs (and perhaps bounce) when standing?
  • Q6: Has your child begun to pass things from one hand to the other?
  • Q7: Does your child bring objects such as toys to their mouth?
  • Q8: Does your child know if someone is not familiar to them and is a stranger?
  • Q9: Does your child respond to other people’s emotions, such as a smile or a frown?
  • Q10: Does your child enjoy looking at themselves in the mirror?
  • Q11: Does your child look at things around them?
  • Q12: Does your child respond to sounds they hear by making sounds themselves?
  • Q13: Does your child make sounds to show joy or displeasure?
  • Q14: Does your child respond to their own name?
  • Q15: Has your child started to string vowels together, such as "ah," "eh," or "oh," or started to say consonant sounds such as "m" or "b"?
  • Q16: Has your child begun to laugh?
BACKBACK5-6-years old child

7-9 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child crawl?
  • Q3: Can your child stand while holding on to something to support them?
  • Q4: Can your child sit without support?
  • Q5: Can your child pull themselves up to stand?
  • Q6: Does your child play peekaboo?
  • Q7: Can your child move things from one hand to the other?
  • Q8: Can your child pick small things up, such as a piece of cereal, with their thumb and index finger?
  • Q9: Does your child look for things that they see you hide?
  • Q10: Does your child watch the path of something as it falls?
  • Q11: Does your child show fear when around strangers?
  • Q12: Does your child become clingy with adults who are familiar to them?
  • Q13: Does your child have favorite toys?
  • Q14: Does your child use their fingers to point?
  • Q15: Does your child understand “no”?
  • Q16: Does your child make a lot of repetitive sounds, such as “mamama” or “bababa”?
  • Q17: Does your child copy the sounds and gestures of other people?
BACKBACK7-9 years old child

10-12 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child stand alone with no support?
  • Q3: Does your child walk while holding on to furniture?
  • Q4: Can your child take a few steps without holding on to anything?
  • Q5: Can your child get into a sitting position without any help?
  • Q6: Does your child bang two things together when playing?
  • Q7: Does your child poke with their index finger?
  • Q8: Has your child started to use things like hairbrushes or drinking cups correctly?
  • Q9: Does your child find hidden objects easily?
  • Q10: Does your child play peekaboo or pat-a-cake?
  • Q11: Does your child become shy or nervous around strangers?
  • Q12: Does your child repeat actions or sounds to get attention?
  • Q13: Does your child put out an arm or leg to help when getting dressed?
  • Q14: Does your child cry when a parent leaves the room?
  • Q15: Does your child show that they have favorite things or people?
  • Q16: Does your child show fear?
  • Q17: Does your child say things such as “mama,” “dada,” or “uh-oh”?
  • Q18: Does your child try to say the words you say?
  • Q19: Has your child started to use gestures like waving or shaking their head “no”?
BACKBACK10-12 years old child

13-18 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child walk by themselves?
  • Q3: Does your child walk up stairs and run?
  • Q4: Does your child pull toys while walking?
  • Q5: Can your child drink from a cup on their own?
  • Q6: Can your child eat with a spoon on their own?
  • Q7: Can your child help undress themselves?
  • Q8: Does your child have occasional temper tantrums?
  • Q9: Does your child show affection to familiar people?
  • Q10: Does your child become clingy in new situations?
  • Q11: Does your child explore their environment alone with parents close by?
  • Q12: Can your child say several single words?
  • Q13: Can your child say and shake their head “no”?
  • Q14: Does your child point to show things to other people?
  • Q15: Does your child scribble?
  • Q16: Does your child know what ordinary products such as phones, spoons, and brushes are used for?
  • Q17: Can your child follow one-step commands such as “sit down” or “stand up”?
  • Q18: Does your child play with a doll or stuffed animal by pretending to feed it?
BACKBACK13-18 years old child

19-23 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Has your child begun to run?
  • Q3: Has your child kicked a ball?
  • Q4: Can your child climb down and onto furniture on their own?
  • Q5: Can your child walk up and down stairs while holding on?
  • Q6: Can your child stand on their tiptoes?
  • Q7: Has your child thrown a ball overhand?
  • Q8: Does your child copy others, especially people older than them?
  • Q9: Does your child get excited around other children?
  • Q10: Has your child shown more independence as they've aged?
  • Q11: Does your child do what they were told not to do and become defiant?
  • Q12: Does your child point to things when they are named?
  • Q13: Does your child know names of familiar people or body parts?
  • Q14: Does your child say 2 to 4-word sentences?
  • Q15: Does your child repeat words they hear?
  • Q16: Does your child complete sentences and rhymes in familiar books?
  • Q17: Does your child name items in books, such as dogs, cats, and birds?
  • Q18: Does your child play simple pretend games?
  • Q19: Has your child started to use one hand more than the other?
  • Q20: Has your child begun to sort shapes and colors?
  • Q21: Does your child follow 2-step instructions, such as “pick up your hat and put it on your head?”
BACKBACK19-23 years old child

24+ MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child run easily?
  • Q3: Can your child climb?
  • Q4: Can your child walk up and down stairs with one foot on each step?
  • Q5: Can your child dress and undress themselves?
  • Q6: Does your child show affection for friends without being told?
  • Q7: Does your child take turns when playing games?
  • Q8: Does your child show concern when others are crying?
  • Q9: Does your child understand the idea of “mine" and "theirs"?
  • Q10: Does your child show many different emotions?
  • Q11: Does your child copy adults and friends?
  • Q12: Does your child separate easily from their parents?
  • Q13: Does your child get upset when there is a major change in their routine?
  • Q14: Does your child say words such as “I,” “me,” “we,” “you,” and some plural nouns?
  • Q15: Can your child say their first name, age, and gender?
  • Q16: Can your child carry on a conversation with 2 to 3 sentences?
  • Q17: Can your child work toys with buttons and other moving parts?
  • Q18: Does your child play pretend with dolls, animals, or people?
  • Q19: Can your child finish 3 or 4 piece puzzles?
  • Q20: Can your child copy a circle when drawing?
  • Q21: Can your child turn pages of a book one page at a time?
  • Q22: Can your child turn door handles?
BACKBACK24 months + old child

Erb’s Palsy Prognosis

Once your child has been diagnosed, your doctor will give you a prognosis. An Erb’s palsy prognosis is the expected outlook of the condition. Thankfully, the overall outlook for brachial plexus palsy is generally very good.

Erb’s Palsy Recovery Outlook

According to a study conducted by Dalhousie University and the IWK Health Centre in Nova Scotia, between 80% and 96% of newborns make a complete recovery from Erb’s palsy.

With prompt and proper therapy, mild cases of Erb’s palsy heal within a few months. However, severe cases may never fully heal, even with treatments like therapy and surgery.

Catching Erb’s palsy as early as possible is the best way to ensure your child can get effective treatment.

Erb’s Palsy Treatment

An Erb's palsy doctor checks a child's arms.Doctors will use your child’s diagnosis and prognosis to determine the best treatment plan for their condition.

Mild cases of stretched nerves may only require physical therapy. More severe cases of torn nerves may require intensive treatment and surgery to help the child regain mobility of their arm, hand, or shoulder.

The key to recovering fully from Erb’s palsy is to start treatment early. Erb’s palsy treatment is most effective when it begins within the first four weeks after the child’s birth.

With proper treatment, most babies with Erb’s palsy will recover completely within 12 months of age.

Learn more about treatment options for Erb’s palsy below.

Physical Therapy

Most cases of Erb’s palsy are mild and can heal with physical therapy.

Physical therapy activities for Erb’s palsy include:

  • Range-of-motion exercises
  • Sensory activities
  • Strength training
  • Stretching

The best type of physical therapy for your child depends on the issues they face. Stretches and range-of-motion exercises can improve a child’s control over their arm, while sensory activities can help to restore any lost feeling.

Doctors may also incorporate water therapy into an Erb’s palsy physical therapy plan to reduce stress on the child’s body and to help them move freely.

Occupational Therapy

Occupational therapy may be used to help children improve the use of their hands and fingers. This type of therapy focuses on these exercises to improve independence and the ability to complete daily tasks.

Occupational therapy can help children refine their skills while:

  • Bathing
  • Brushing their teeth and hair
  • Drawing
  • Dressing
  • Eating and drinking
  • Writing

Surgery

Surgery for Erb’s palsy can repair damage to brachial plexus nerves that will not heal on their own, such as avulsions. It is typically used only if your child does not show improvement despite other treatment options.

Nerve or tendon transfers remove healthy nerves from another part of the body to repair damaged brachial plexus nerves. Doctors may even decide to completely remove severely damaged nerve fibers that cannot be repaired.

While a more drastic measure than regular therapy, surgery is often successful. Researchers in
Nova Scotia reported that surgery improved the symptoms of Erb’s palsy in roughly two-thirds of patients.

Legal Help for Erb’s Palsy

Many cases of Erb’s palsy are caused by medical mistakes during delivery. Doctors, nurses, and other health care providers who commit acts of medical negligence during the birthing process can cause significant damage to the brachial plexus.

Medical professionals who cause preventable birth injuries should be held accountable for their actions. Your family should not be responsible for paying for your child’s Erb’s palsy treatment if the injury was preventable.

Thankfully, you may qualify for financial assistance through a medical malpractice claim. Compensation from a legal settlement can help you pay for your child’s Erb’s palsy treatment in hopes that they’ll fully recover.

If you believe your child’s Erb’s palsy stems from medical negligence during birth, get a free case review now to learn more about your right to compensation.

Erb’s Palsy FAQs

What causes Erb’s palsy?

Excessively pulling, stretching, or twisting the brachial plexus nerve network can cause a child to develop Erb’s palsy during the birthing process.

Can Erb’s palsy be fixed?

Yes. Although every case is different, most cases of Erb’s palsy can be completely or partially fixed.

How can I give my child the best chance of a full recovery from Erb’s palsy?

The best way to help your child fully recover from Erb’s palsy is to get a prompt diagnosis and proper treatment.

The sooner your child is accurately diagnosed with Erb’s palsy, the sooner they are able to get treatment to manage their condition. Treatment focuses on helping the child regain strength and mobility in the affected arm in an effort to make a full recovery.

Is Erb’s palsy preventable?

It depends. Some cases of Erb’s palsy are caused by risk factors that may not be preventable. However, many cases are caused by lack of care during delivery.

Some medical professionals may use excess force during delivery, causing brachial plexus damage. In these situations, medical negligence may be to blame.

To find out if your child’s brachial plexus palsy may have been preventable, contact us today.

Birth Injury Support Team
Reviewed by:Beth Carter

Registered Nurse, Legal Nurse Consultant Certified

  • Fact-Checked
  • Editor

Beth Carter has over 18 years of experience as a Registered Nurse. She spent nearly half of that time working in labor and delivery units. This, combined with her own experience giving birth to a premature baby, ignite Beth’s passion for helping new mothers access the information and resources they deserve.

The Birth Injury Justice Center was founded in 2003 by a team of legal professionals to educate and empower victims and families affected by birth injuries. Our team is devoted to providing you with the best resources and legal information for all types of birth injuries.

View 6 Sources
  1. Basit, H. (2021, November 5). Erb Palsy. StatPearls [Internet]. Retrieved February 8, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK513260/
  2. Chater, M., Camfield, P., & Camfield, C. (2004, October 1). Erb's palsy – who is to blame and what will happen? OUP Academic. Retrieved February 8, 2022, from https://doi.org/10.1093/pch/9.8.556
  3. Erb's palsy (brachial plexus birth palsy) - orthoinfo - AAOS. OrthoInfo. (n.d.). Retrieved February 8, 2022, from https://orthoinfo.aaos.org/en/diseases--conditions/erbs-palsy-brachial-plexus-birth-palsy
  4. Mayo Foundation for Medical Education and Research. (2020, April 15). Brachial plexus injury. Mayo Clinic. Retrieved February 8, 2022, from http://www.mayoclinic.org/diseases-conditions/brachial-plexus-injury/symptoms-causes/syc-20350235.
  5. Nerve conduction studies. Johns Hopkins Medicine. (n.d.). Retrieved February 8, 2022, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/nerve-conduction-studies#:~:text=A%20nerve%20conduction%20velocity%20
  6. U.S. Department of Health and Human Services. (n.d.). Klumpke paralysis. Genetic and Rare Diseases Information Center. Retrieved February 8, 2022, from https://rarediseases.info.nih.gov/diseases/3123/klumpke-paralysis
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