Understanding Erb’s Palsy

Erb’s 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 leads 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. Erb’s palsy occurs when the collection of nerves around the shoulder 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 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 damages 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 palsy.

Erb’s palsy can cause many issues for your child. They may not be able to grasp, eat 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 fully recover from it. 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 unnoticed 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 as a whole, you can seek treatments that will work best for your child.

Causes of Erb’s Palsy

Erb’s palsy is almost always caused by an injury or trauma during the delivery process. One of the most common causes of Erb’s palsy is a condition caused 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 pulled out. However, physically pulling on a baby during delivery can stretch or tear their nerves in their shoulder.

Other common causes 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

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

The four types of nerve damage are:

  • Neurapraxia: stretching of the nerve without tearing
  • Rupture: tearing of the nerve without separation from the spinal cord
  • Avulsion: the nerve tears away from the spine and will not heal on its own
  • Neuroma: the growth of scar tissue around the injury that places pressure on healthy, uninjured nerves, preventing these nerves from sending signals to the muscles

When the upper nerves around the shoulder or 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 lower nerves 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 arms through different treatment methods.

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 appear to 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. They may also have the condition if they use one hand exclusively to pick up or grasp objects. One symptom of Erb’s palsy in newborn babies is a limp or unresponsive arm or hand.

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. A doctor will conduct a few different tests to determine if your child has Erb’s palsy.

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

The key to total recovery is starting treatment early. Early treatment allows your child’s body to grow stronger and 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 a year if proper treatments are sought.

The good news is that most cases Erb’s palsy are mild and can heal through 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 by itself. These cases might need surgery to aid the recovery process.

Therapy for Erb’s Palsy

Physical therapy for Erb’s palsy is the most common treatment method. Physical therapy 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 activities can improve a child’s control, while sensory activities can 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 surgery for Erb’s palsy to repair the damaged nerves if their symptoms are not responsive to other treatments or therapy. Surgery 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 process allows the body to restore movement and function in places with damaged nerves. Doctors can also remove nerves 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.

Author:Birth Injury Justice Center
Birth Injury Justice Center

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.

Last modified: June 21, 2019

View 3 References
  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724163/
  2. https://rarediseases.info.nih.gov/diseases/3123/klumpke-paralysis
  3. https://www.mayoclinic.org/diseases-conditions/brachial-plexus-injury/symptoms-causes/syc-20350235

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