Erb’s Palsy

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

Erb’s palsy (brachial plexus palsy) can develop in your child if they are pulled on during delivery. Pulling on a child’s feet, shoulders, head, or arms can cause nerve damage or tearing. This damage can lead to a lack of feeling or control in the affected limbs. It can also lead to paralysis in severe cases.

What Is Erb’s Palsy?

Erb’s palsy is a condition where a baby cannot properly use their arm, shoulder, or hands. Their affected limbs could be weak, lack feeling, or totally paralyzed. Obstetric Erb’s palsy occurs when the collection of nerves around the shoulder (brachial plexus nerves) are damaged during a difficult delivery.

According to the American Academy of Orthopedic Surgeons (AAOS), Erb’s palsy affects about one out of 1,000 newborns.

Erb’s palsy results from damage that could have been caused around the time at birth. Usually, Erb’s palsy is caused when a doctor or nurse pulls on a stuck baby during delivery. This pulling can damage the brachial plexus, a network of nerves that sends signals from the spine to the shoulders, arms, and hands. This is why the condition is also known as brachial plexus birth palsy.

Erb’s palsy can cause many issues for your child. They may not be able to grasp, feed themselves, or put on their clothes properly. These issues can be frustrating and lead to other problems.

Fortunately, Erb’s palsy is a highly treatable condition and most children can achieve a complete recovery. Because Erb’s palsy is not caused by brain damage, it often is not as dangerous to your child’s health as cerebral palsy.

However, without proper treatment, your child could be handicapped for the rest of their life. To make matters worse, Erb’s palsy may go undiagnosed in the months or years following your child’s birth. This can complicate the treatment process, as prompt treatment is most effective.

It is important that you know the causes, symptoms, and treatment options of Erb’s palsy if you suspect your child has the condition. By understanding the condition, you can seek treatments that will work best for your child.

Causes of Erb’s Palsy

Erb’s palsy is often caused by an injury or trauma during the delivery process. One of the most common causes of Erb’s palsy is a condition called shoulder dystocia.

When an infant’s shoulder is caught behind the mother’s pubic bone during childbirth, it is known as shoulder dystocia. When a baby’s shoulder gets caught, it must be released. However, physically pulling on a baby during delivery can stretch or tear the healthy nerves in their shoulder.

Other risk factors of Erb’s palsy include:

  • The baby’s head and neck pulling toward the side as the shoulders pass through the birth canal
  • Pulling the baby’s shoulders during a head-first delivery
  • Pulling on the baby’s feet during a feet-first (breech) delivery, which puts too much pressure on the infant’s arms
  • Shoulder dislocation or fractures in the collarbone (clavicle)

The extent of the nerve damage determines how serious your child’s condition will be.

The four types of nerve injuries are:

  • Neurapraxia: stretching of the nerve without tearing
  • Neuroma: a stretch injury that may cause scar tissue
  • Rupture: tearing of the nerve without separation from the spinal cord
  • Avulsion: the nerve tears away from the spinal cord and will not heal on its own

When the upper nerves around the shoulder or upper arm are damaged, Erb’s palsy develops. Erb’s palsy is the most common form of brachial plexus injury. Other brachial plexus injuries can also occur depending on what nerves are affected.

When the nerves in the lower arm are damaged, the injury leads to a condition known as Klumpke’s palsy. When both the lower and upper nerves of the brachial plexus are injured, total brachial plexus palsy results. These conditions are much rarer than Erb’s palsy, but present similar symptoms and respond to the same treatments.

Sadly, Erb’s palsy is often preventable with proper medical care during birth. Many of these causes can stem from medical negligence, such as the doctor using excessive force during delivery. Fortunately, most children can regain use of their affected arm or the affected side of the body through different treatment methods.

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Symptoms of Erb’s Palsy

There are a few notable signs of Erb’s palsy. These signs include a lack of use or feeling in the shoulder, arms, or hand. In severe cases, someone with Erb’s palsy may not be able to move the affected limb at all. What symptoms of Erb’s palsy develop will depend on the extent of the damage.

People diagnosed with Erb’s palsy later in life will often complain of numbness or tingling in the affected limbs. However, they still may be able to use those limbs to an extent. This can make their Erb’s palsy difficult to diagnose, as it could be mistaken for other conditions.

Concerned parents of newborns should monitor their child’s movements and make note of anything suspicious. If one of your child’s arms hangs limp, they may have Erb’s palsy. One symptom of Erb’s palsy in newborn babies is a limp or unresponsive arm or hand. They may also have the condition if they use one hand exclusively to pick up or grasp objects.

When looking at symptoms, it is important to note how long they last. Because Erb’s palsy is caused by significant nerve damage, the condition will often not clear up for months or even years and the symptoms persist over that time. They may even get worse.

Diagnosis of Erb’s Palsy

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

A doctor will conduct a few different tests to determine if your child has Erb’s palsy. Common Erb’s palsy assessment tests include a physical examination of the affected limbs as well as tests like MRI and CT scans. Physical examinations look for outward signs of the condition, such as a lack of feeling or control in the limbs in question. Electronic scans of the body check parts of the nerve system for damage. These scans can not only determine if there has been damage but how bad it is.

Once a diagnosis has been made, a doctor will inform you of the expected prognosis and available treatments for your child’s case of Erb’s palsy. Stretched nerves will often only require physical therapy, as they can often heal on their own with muscle conditioning. However, if the tests indicate that your child’s nerves are torn, they may also need surgery for their condition.

Because the recovery process for Erb’s palsy can take months or even years, you should plan regular visits to your child’s doctor. By keeping your health care provider informed, they will be able to advise you if complications arise or if different treatment methods may be more helpful.

Prognosis of Erb’s Palsy

A prognosis for Erb’s palsy comes after a doctor has properly diagnosed your child. The prognosis tells you the average progression of a disease or condition. In general, most cases of Erb’s palsy have good outlooks.

Erb’s palsy has a much better outlook when compared to other birth injuries. According to a research study conducted by Dalhousie University and the IWK Health Centre in Nova Scotia, 80% to 96% of newborns will completely recover from Erb’s palsy.

With prompt and proper therapy, Erb’s palsy can often be totally healed within a year’s time. However, this may not always be the case. Some severe cases of Erb’s palsy will not fully heal, even with therapy and surgery. Additionally, if Erb’s palsy is not caught early enough, treatments will not be as effective.

Erb’s Palsy Treatment

After doctors make a diagnosis, they will advise you on available Erb’s palsy treatments. These treatments may allow your child to regain the use of their affected shoulder, arm, and/or hand.

The key to recovery is starting treatment early. Early treatment allows your child’s body to grow stronger and potentially heal itself. Treatment is most effective when it begins within the first four weeks after the child’s birth. Most babies with Erb’s palsy will recover completely within 12 months of age if proper treatments are sought.

The good news is that most cases of Erb’s palsy are mild and can heal with physical therapy. If the nerves are simply stretched, movement and feeling can eventually return to the affected arm. Because a child with Erb’s palsy typically cannot move the affected limb independently, frequent physical therapy is encouraged to properly treat the condition.

However, there are some cases where Erb’s palsy will not heal with therapy alone. These cases might need surgery to aid in the recovery process.

Therapy for Erb’s Palsy

Physical therapy for Erb’s palsy is a common treatment. Therapy for Erb’s palsy combines exercises, stretching, and other movements to repair the damage done at birth. By doing physical therapy over a period of several months, most children are able to recover from Erb’s palsy.

What types of physical therapy will work for your child depends on the issues they face with their condition. Stretches and range-of-motion exercises can improve a child’s control, while sensory activities can help to restore any lost feeling.

Physical therapy is performed by a specialized therapist in a hospital or treatment setting. A physical or occupational therapist can also teach you how to perform therapy on your child at home.

Working alongside licensed professionals will allow you to track your child’s recovery. If you are not seeing noticeable improvements, you may need to try different forms of therapy or surgery.

Surgery for Erb’s Palsy

A doctor might recommend surgical treatment for Erb’s palsy to repair the damaged nerves if their symptoms are not responsive to other treatments or therapy. Surgery for Erb’s palsy can repair damage to nerves that will not heal on its own.

Surgery to correct Erb’s palsy typically will transfer good nerves from one part of the body to the affected area. This nerve transfer (also called tendon transfer) process allows the body to potentially restore movement and function in places with damaged nerves. Doctors can also remove nerve fibers that are beyond saving.

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 based on previous studies.

However, surgery should not be the first option to consider. It is typically used only if your child does not show improvement despite other treatment options.

Affording Erb’s Palsy Treatments

Erb’s palsy treatments can help children with the condition regain some control over the affected limb or even recover completely. That being said, it can take years to recover — and the medical expenses can be very hard to afford.

To help pay for these treatments, you can take legal action in the form of an Erb’s palsy lawsuit. A lawsuit could reward you with the money you need to pay for your child’s expenses. Learn more by getting in touch with our team today.

Birth Injury Support Team
Nurse BethReviewed by:Beth C.

Registered Nurse, Legal Nurse Consultant Certified

  • Fact-Checked
  • Editor

Beth C. 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.

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