Erb’s Palsy

What Is Erb’s Palsy?

Erb’s palsy, also called brachial plexus birth palsy or Erb-Duchenne palsy, is a condition caused by nerve damage around the time of birth.

Doctors or nurses pulling on a baby during a difficult delivery can damage the brachial plexus, or the network of nerves that sends signals from the spine to the shoulders, arms, and hands. The resulting condition, Erb’s palsy, prevents the baby from properly using their affected limb.

According to the American Academy of Orthopedic Surgeons (AAOS)

Erb’s palsy can cause difficulties in completing daily tasks, such as eating and getting dressed. Fortunately, the condition is highly treatable, and most children can achieve a complete recovery.

Types of Erb’s Palsy Injuries

The severity of a child’s condition depends on the type of nerve damage that occurs:

• 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 root tears away from the spinal cord and will not heal on its own

Causes of Erb’s Palsy

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 in that area.

Other situations that may cause Erb’s palsy:

• The baby’s head and neck pulling sideways as they 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)

Variations of Brachial Plexus Injuries

These injuries are much rarer than Erb’s palsy, but present similar symptoms and respond to the same treatments.

• Klumpke’s Palsy: This type of injury involves nerve damage in the lower arm.
• Total Brachial Plexus Palsy: This condition involves nerve injury in both the lower and upper arm.

Symptoms of Erb’s Palsy

Notable signs of Erb’s palsy include:

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

What symptoms develop will depend on the severity of the injury. In extreme cases, someone with Erb’s palsy may not be able to move their affected limb at all.

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.

Common Erb’s palsy assessment tests include:

• Physical examination
• MRI
• CT scan
• Nerve conduction study

Physical examinations look for outward signs of the condition. Electronic scans of the body, such as an MRI or CT scan, check to see if there has been nerve damage — and how bad the damage is.

Prognosis of Erb’s Palsy

Once your child has been diagnosed, your doctor will give you a prognosis, or the expected outlook of the condition. Erb’s palsy has a much better outlook than many other birth injuries.

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 therapy and surgery. Catching Erb’s palsy as early as possible is the best way to ensure effective treatment.

Erb’s Palsy Treatment

Your child’s diagnosis and prognosis inform their Erb’s palsy treatment plan.

Stretched nerves may only require physical therapy, as they can often heal on their own with muscle conditioning. Torn nerves, however, may also require surgery. All Erb’s palsy treatments are intended to help your child to regain use of their affected shoulder, arm, and/or hand.

The key to recovery is starting treatment early. Treatment is most effective when it begins within the first four weeks after the child’s birth.

Physical Therapy

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

Physical therapy activities for Erb’s palsy include:

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

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, while sensory activities can help to restore any lost feeling.

Getting Physical Therapy

Therapy for Erb’s palsy is performed by a licensed professional in a hospital or treatment setting. A physical or occupational therapist can also teach you how to perform therapy on your child at home and track their recovery.

If you are not seeing noticeable improvements, you may need to try different forms of therapy or surgery.

Other Therapies

In addition to physical therapy, your child may also benefit from other types of therapy to help their brachial plexus heal.

Other Erb’s palsy therapies include:

• Hydrotherapy: Physical therapy in water to minimize stress on the body and allow your child to move through therapy with less pain
• Occupational therapy: Usually needed after surgery to help patients improve on day-to-day tasks such as eating, playing, and drawing
• Botulinum toxin injections: Botox injections are used to reduce contractures (tightening of the muscles, ligaments, and tendons)

Regardless of treatment type, you should plan regular visits to your child’s doctor who will monitor their progress and suggest other treatment methods if needed.

Surgery

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

Erb’s palsy surgical treatments may involve:

• Transfering good nerves from another part of the body (called tendon or nerve transfer)
• Removing severely damaged nerve fibers

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.

Living With Erb’s Palsy

Erb’s palsy may affect certain aspects of your child’s life, both physically and emotionally. But children are adaptable — and there are many support outlets to give your child their best chance at a healthy life in every way.

Support Groups

Families affected by Erb’s palsy may benefit greatly from joining support groups. These groups bring people together and provide a safe place to exchange stories and resources, share concerns, and build strength to face whatever the future brings.

To find an Erb’s palsy support group, consider contacting:

• Your child’s doctor
• Shriners Hospital for Children
• March of Dimes
• National Association of Parents with Children in Special Education (NAPCSE)
• Federation for Children with Special Needs

5 Life Tips From a Teen With Erb’s Palsy

Boston Children’s Hospital offers 5 tips directly from a 16-year-old patient living with Erb’s palsy.

1. Have a good support system, including surrounding yourself with supportive friends.
2. Meet other children with Erb’s palsy with whom you can share experiences.
3. Find an outlet (such as writing or music) to help let out any anger, frustration, and feelings of unfairness.
4. Be your own advocate when it comes to your treatment and educating other people about Erb’s palsy.
5. Stay positive and don’t let Erb’s palsy hold you back from doing anything.

Erb’s Palsy Financial Support Options

Treatment for Erb’s palsy can be costly, however, there are many organizations that offer resources and information on Erb’s palsy grants and benefits.

Some helpful resources include:

• United Brachial Plexus Network (UBPN)
• Disabled Children’s Relief Fund
• United Healthcare Children’s Foundation

If you suspect your child’s Erb’s palsy was caused by a mistake made by your health care team, you may also be able to access financial support through a lawsuit.

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Beth C., RN

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Erb’s Palsy Legal Help

Since Erb’s palsy is often caused by an injury or trauma during the delivery process, it’s possible that your child’s condition could have been prevented.

A qualified birth injury lawyer can help you determine if a health care worker was responsible for your child’s Erb’s palsy — and, if so, fight on your family’s behalf to pursue the compensation you deserve.

Some reported awards in Erb’s palsy lawsuits include:

• $1.2 million in the case of a ten-year-old South Carolina girl
• $1 million in the case of a thirteen-year-old South Carolina girl
• $975,000 in the case of a six-year-old Florida boy
• $850,000 in the case of a New York infant

Get a free case review now to find out if your family is entitled to money to help cover your child’s costs of care.

Frequently Asked Questions About Erb’s Palsy