Erb’s Palsy Assessments

When a child’s arm is weaker than usual due to nerve damage at birth, their condition is known as Erb’s palsy. Most children with Erb’s palsy fully recover with the right treatment. To receive the best treatment, children need to be assessed to correctly diagnose their condition and determine the extent of the damage.

Erb’s Palsy Assessments Explained

Erb’s palsy is also called brachial plexus palsy because it’s caused by damage to the brachial plexus nerves. These nerves control a person’s shoulders and arms, which is why a weak or paralyzed arm is one of the most common Erb’s palsy symptoms.

Erb’s palsy is not the only condition that can cause your child to have a weak arm. Because there are different disorders with similar symptoms, doctors will conduct a series of assessments to evaluate your child’s mobility, the specific type of damage causing the problems, the extent of that damage and any other related neurological issues.

Different assessments focus on various aspects of Erb’s palsy. Some assessments focus on how much your child can move their affected arm. Others look at the extent of the nerve damage in your child’s shoulder or arm to determine a treatment plan.

What are Erb’s Palsy Assessments?

All newborns undergo a general assessment immediately after delivery. During the newborn assessment, doctors may screen them for Erb’s palsy. When doctors assess your child for Erb’s palsy, they look at whether or not your child has any weakness, loss of feeling or paralysis (partial or complete) in their affected arm.

If doctors discover symptoms during the newborn assessment, then they will likely request a follow-up appointment in roughly 48 hours. If nothing appears off in the newborn assessment, doctors can observe ongoing developmental milestones. This includes if your child does not start crawling on time or if your child constantly tells you that their arm feels funny.

The sooner doctors catch the problem, the sooner your child can receive the correct Erb’s palsy treatments. The earlier treatment starts, the higher the chance of your child will fully recover.

Between 70% to 80% of children with Erb’s palsy will fully heal within the first year of their life if they began to receive the correct treatment within 4 weeks of birth.

Erb’s Palsy Assessment Tools

Some of the tools your child’s doctor will use to conduct their assessments are X-rays, MRIs and electrodes. The various tests look for different issues—shoulder dislocations, damage to the brachial plexus or the amount of electrical activity in your child’s muscle.

While these are generally low-risk procedures your child might need to be sedated to stop them from moving while doctors are running the tests. This will allow them to get accurate readings from the tests.

Types of Erb’s Palsy Assessment and Tests

Doctors use different diagnostic approaches to determine if a child has Erb’s palsy. Examples include neurological tests, physical assessments and imaging and electrodiagnostic assessments.

Neurological and Sensation

Neurological assessments study your child’s muscle tone, reflexes, spontaneous movements and sensations. One way doctors administer neurological tests is through deep tendon reflex tests. During a deep tendon reflex test, a doctor will tap your child’s elbow with a reflex hammer or possibly their finger to see if your child reacts.

Doctors focus on 6 primitive reflexes—the natural reactions to different sources of stimulation—during their tests.

These primitive reflexes are:

  • Moro or startle reflex
  • Placing or rooting reflex
  • Grasp reflex
  • Asymmetrical tonic neck reflex (ATNR) or fencing reflex
  • Forward protective response
  • Sideward protective responses

Different reflexes appear and disappear at different ages, so the age of your baby will determine which the doctor will test. For example, the startle, rooting and grasp reflexes are present birth but generally disappear around the 6-month mark. The ATNR appears around 6 weeks and the protective response reflexes don’t show up until a child is at least 6 months old.

Sensation tests focus on behavioral cues. For example, doctors will watch your child’s face and body to see if they grimace or pull their arm back when the doctor is moving or pinching it lightly.

In addition to testing physical symptoms, doctors use Erb’s palsy assessments to determine a child’s level of pain or psychological distress.

Movement and Motor Tests

There are two main motor and movement tests doctors can conduct to assess for Erb’s palsy: the passive range-of-motion (PROM) examinations and the active movement scale (AMS).

  • Passive Range-of-Motion: During these tests, a doctor moves your child’s shoulder and arm through different motions, such as across their chest to straight out to their side. This happens before and after your child’s diagnosis to prevent your child’s muscles or joints from being permanently shortened.
  • Active Movement Scale: The AMS can be used from birth until adolescence. In this test, doctors look at your child’s purposeful range of motion compared to the field of motion they had when the doctor was moving their joints. There are 2 parts to this test. The first is to see how much movement your child has when working with gravity. The second is to see how far they can move when working against gravity.

Imaging and Electrodiagnosis

One imaging test that doctors may use to assess your child is an MRI (Magnetic Resonance Imaging). For this test, your child will likely be sedated before they are put into a scanner that uses a large magnet, radio waves and a computer to create images of the inside of their body. These images allow doctors to pinpoint where and how extensive the damage is.

Another test is the electromyogram (EMG). There are 2 parts to an EMG. In the first part, doctors insert tiny electrode needles into your child’s muscles to read the amount of electrical activity in the muscle. In the second part, sticker-like electrodes are placed on your child’s skin to study the speed and strength of the electrical signals.

Erb’s Palsy Assessment Follow-Ups

While a diagnosis is a one-time thing, assessments will continue after your child has begun treatment. Before an Erb’s palsy diagnosis, doctors use assessments to determine the extent of your child’s condition and start an effective therapy plan.

After diagnosis, assessments help your doctor monitor any changes in your child (such as if they are getting better) and prescribe new treatment plans to allow your child to keep moving forward in their recovery.

Legal Help for Erb’s Palsy

Erb’s palsy may be the result of birth injuries. For example, if the baby gets stuck in the cervix, the doctor might have to pull the baby out. This may cause an unnatural stretch between their head and shoulder.

If you believe your child was injured due to medical negligence, Erb’s palsy assessments can help ensure your child receives the right treatment plan based on the extent of the injury. Financial compensation may be available to you to help pay for your child’s medication, treatment, therapy and special needs costs.

Work with an attorney experienced in Erb’s palsy cases. Contact the Birth Injury Justice Center today at 800-914-1562 and get a free medical case review.

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: January 8, 2019

View 4 References
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  2. “Electromyography (EMG)” Mayo Clinic. Retrieved from: https://www.mayoclinic.org/tests-procedures/emg/about/pac-20393913. Accessed December 12, 2018.

  3. “Neural Exam – Newborn reflexes – deep tendon reflexes” UNSW Embryology. Retrieved from: https://embryology.med.unsw.edu.au/embryology/index.php/Neural_Exam_-_Newborn_reflexes_-_deep_tendon_reflexes. Accessed December 14, 2018.

  4. “What to know about MRI scans” Medical News Today. Retrieved from: https://www.medicalnewstoday.com/articles/146309.php. Accessed December 13, 2018.