Erb’s Palsy Causes

Fact-Checked and Medically Reviewed by:
Katie Lavender, RN Registered Nurse
Quick Answer

Erb’s palsy is a condition resulting from a nerve injury to the head or neck during delivery. It can be caused by a doctor’s use of improper tools or delivery methods. Fortunately, Erb’s palsy is treatable. A full recovery can often be achieved through ongoing physical therapy. Additionally, only a fraction of Erb’s palsy cases require surgery.

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What Are the Common Causes of Erb’s Palsy?

Erb’s palsy is a brachial plexus injury often caused by damage to the head or neck during childbirth. When a child’s head or shoulders are pulled on too hard, the nerves can become stretched or torn. This injury can be caused by doctors who use tools such as forceps or delivery methods such as vacuum extraction.

Common Erb’s palsy causes include:

  • Pulling on an infant’s head and neck as the shoulders pass through the birth canal
  • Pulling an infant’s shoulders during a head-first delivery
  • Pulling on an infant’s feet during a feet-first (breech) delivery, which puts too much pressure on the infant’s raised arms

However, there are some Erb’s palsy cases that are not caused by birth injuries. Traumatic injuries from contact sports and car accidents can also cause Erb’s palsy.

Potential causes of Erb’s palsy should be examined carefully to determine if medical negligence has occurred. With proper medical care, Erb’s palsy can be often be avoided. Experienced medical professionals understand how to conduct a delivery without a high risk of damaging the child’s head or neck area.

Although most cases of Erb’s palsy are mild and can heal on their own, there are more severe cases that will require surgery and a lifetime of treatment.

Shoulder Dystocia

Shoulder dystocia is a condition that can develop when the child’s head is delivered during childbirth, but his or her shoulders remain stuck in the mother’s body. Shoulder dystocia is associated with a difficult delivery and can cause several serious birth complications.

In most cases, shoulder dystocia will not cause any permanent damage. However, it can sometimes lead to an injury of the nerves in the shoulder, arm, wrist, hand and fingers. In the most extreme cases, it can reduce oxygen flow to the brain and cause brain damage.

The medical team at delivery must act quickly. Delaying intervention by minutes can cause severe birth trauma.

When shoulder dystocia injures the nerves responsible for the arm and shoulder, it can cause Erb’s palsy.

Shoulder dystocia can be quickly corrected by the following procedures:

  • Episiotomy, which cuts a wide opening in the posterior vaginal wall
  • Doctor carefully turning the baby’s shoulder while still inside the mother
  • Doctor carefully applying pressure to the mother’s lower stomach area
Nurse’s Note:

When the head is delivered, but the shoulders are stuck behind her pubic bone, the physician will direct the nurses to apply suprapubic pressure. This is where the nurse will stand on a stool to push firmly downward on a mother’s abdomen, right above her pubic bone.

Risk Factors of Shoulder Dystocia

Shoulder dystocia has certain risk factors. Mothers and babies who fit these profiles have a higher risk of this condition occurring during delivery.

Shoulder dystocia risk factors include:

  • Maternal diabetes: One-third of mothers with diabetes who give birth to a child with an above-average weight will experience shoulder dystocia during childbirth.
  • Maternal obesity: Obesity can make it difficult for a child to successfully leave the birth canal.
  • Operative vaginal birth: Tools such as forceps and delivery methods like vacuum extraction can actually delay the child’s delivery and cause shoulder dystocia when used prematurely and incorrectly.
  • Child born after due date: Children born after their due date are typically larger and may have a harder time leaving the birth canal.
  • Multiple babies at once: Women who have multiple children at once are at greater risk of shoulder dystocia during pregnancy.

Shoulder Dystocia Symptoms

In the short term, shoulder dystocia can cause a difficult, lengthy delivery process. For most mothers and their children, this is where the problems end. However, for some babies, shoulder dystocia is just the beginning of an injury with long-term symptoms.

If shoulder dystocia causes an injury to the nerves that control the arm and shoulder or causes oxygen deprivation during pregnancy, the symptoms can be long-lasting and significant.

Long-term effects of a birth injury resulting from shoulder dystocia include:

  • The inability to turn the head
  • Arms that cannot hug or reach out
  • The inability to write or pick things up

If oxygen does not reach the brain during delivery due to shoulder dystocia, it can cause brain damage and/or cerebral palsy.

If your child has muscle weakness or paralysis in their shoulder, arm, wrist, hand or fingers after shoulder dystocia, it is important to contact a doctor immediately.

Treatment Options

If your child is injured during birth because of shoulder dystocia, the type of treatment required will vary based on the seriousness of the injury. If the injury caused Erb’s palsy, the typical course of action is a medical evaluation followed by therapy and follow-up evaluations.

Children born with Erb’s palsy make a complete recovery in over 80% of cases. In about 5% of cases, surgery will be required for a full recovery.

Shoulder dystocia can lead to serious complications if left untreated. Therefore, make sure that your child has an immediate medical evaluation if they display any symptoms of muscle weakness or nerve damage.

Erb’s Palsy Outlook

Although Erb’s palsy can be quite frightening for new parents, the good news is that the condition is highly treatable. The overwhelming majority of children diagnosed with Erb’s palsy will recover after physical therapy. However, there is a small but real chance that treatment will not cure the condition.

If your child’s Erb’s palsy was caused by medical negligence, such as excessive force used during delivery, then your family may be eligible for a financial settlement. This settlement may be able to pay for some or all of your child’s health care expenses.

In many cases, Erb’s palsy or shoulder dystocia can be prevented with proper medical care.

Birth Injury Support Team
Reviewed by:Katie Lavender, RN

Registered Nurse

  • Fact-Checked
  • Editor

Katie Lavender has over 8 years of experience as a Registered Nurse in postpartum mother/baby care. With hands-on experience in Labor and Delivery and a role as a Community Educator for newborn care, Katie is a staunch advocate for patient rights and education. As a Medical Reviewer, she is committed to ensuring accurate and trustworthy patient information.

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 Sources
  1. American Academy of Orthopaedic Surgeons (AAOS). “Erb’s Palsy (Brachial Plexus Birth Palsy).” Retrieved November 25, 2023, from–conditions/erbs-palsy-brachial-plexus-birth-palsy
  2. Baptist Health. “Erb’s Palsy (Erb Duchenne Palsy).” Retrieved November 25, 2023, from
  3. Beth Israel Lahey Health Winchester Hospital. “Health Library – Shoulder Dystocia.” Retrieved November 25, 2023, from
  4. Johns Hopkins Medicine. “Brachial Plexus Injury.” Retrieved November 25, 2023, from
  5. March of Dimes. “Shoulder Dystocia.” Retrieved November 25, 2023, from