Erb’s Palsy Treatment

Quick Answer

Over 80% of children diagnosed with Erb’s palsy will make a full recovery and regain complete control of the muscles in their affected arm. Many Erb’s palsy cases can be treated with physical therapy, but more severe cases may require surgery. Studies have shown that starting treatment for Erb’s palsy as quickly as possible greatly increases the chance of a full recovery.

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Common Erb’s Palsy Treatment Options

Erb’s palsy occurs when the brachial plexus network of nerves are injured during childbirth. This can occur when a doctor or nurse uses excessive force when pulling the baby’s arm, shoulder, or neck out of the birth canal during a difficult delivery.

Treatments for brachial plexus injuries can vary depending on the severity of nerve damage. Neuropraxias are generally mild and clear up on their own at three months of age, whereas more severe injuries such as avulsions (nerve roots are torn from the spinal cord) may require intensive treatment.

Erb’s palsy treatment options generally include physical therapy and occupational therapy for mild cases, and more intensive surgery for more severe cases.

Your doctor will recommend a treatment plan that is best for your child’s particular case of Erb’s palsy to give them the best chance of recovery. The treatments used will depend on your child’s condition and symptoms.

It is important to seek Erb’s palsy treatments as soon as your child is diagnosed to lessen the chances of long-term or permanent disability.

Physical Therapy for Erb’s Palsy

Physical therapy is the primary treatment of Erb’s palsy. Physical therapy helps children regain strength and control in the affected arm, allowing many to heal without other treatment methods.

Erb’s palsy physical therapy can start as early as two weeks after the child is born. However, if your child is diagnosed at birth, your medical provider will likely provide you with a list of guidelines for handling your child so that you do not harm their affected arm before they start therapy.

These guidelines include the following:

  • Allow time for any inflammation from the birth injury to settle down
  • Do not lift a child under the arms
  • Protect the affected arm by carefully handling the baby
  • When dressing the child, place the affected arm into the sleeve first, then the head and the unaffected arm

Many children with Erb’s palsy are able to partially or fully recover with physical therapy.

Erb’s Palsy Treatment After Two Weeks of Age

Once a child with Erb’s palsy is two weeks old, they can begin intensive physical therapy for their affected arm or shoulder.

In these cases, the treatment is typically conducted with a licensed physical therapist on a weekly or biweekly basis.

Erb’s palsy physical therapy can help relieve stiffness and return range of motion in the child’s affected arm. Physical therapists will use several different range-of-motion exercises, equipment, and massage therapy to help babies regain strength.

Physical therapy treatment techniques can vary depending on the child’s specific needs and severity of the injury. The physical therapist may provide parents with additional physical therapy instruction to complete at home as well.

The treatment usually involves the following:

  • Adaptive equipment like splints to prevent contractures
  • Daily home-based stretching and exercise
  • Gentle passive motion of joints
  • Monthly follow-up at a clinic
  • Weekly or biweekly formal physical therapy

If you believe your child suffered from Erb’s palsy from childbirth, talk to one of our caring registered nurses to learn more about next steps.

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Occupational Therapy for Erb’s Palsy

Another form of Erb’s palsy treatment is occupational therapy. This type of therapy focuses on improving fine motor skills of the affected arm.

Because Erb’s palsy is caused by damage to the brachial plexus nerves, it can greatly impact the use of the child’s arm, wrist, hand, and/shoulder. This can make it difficult for children to complete everyday tasks and chores.

Occupational therapists use a variety of techniques to reduce muscle weakness and improve a child’s motor skills.

Occupational therapy can help children complete daily activities such as:

  • Bathing
  • Brushing teeth/hair
  • Drawing
  • Drinking from a cup
  • Eating with utensils
  • Getting dressed
  • Writing

The overall goal of Erb’s palsy occupational therapy is to help children become as independent as possible. Starting occupational therapy early may improve the quality of life for children with Erb’s palsy.

IS YOUR CHILD MISSING DEVELOPMENTAL MILESTONES?

Take Our Milestones Quiz

Taking note of your child’s physical, social, and emotional skills can help you determine if they potentially suffered from an injury at birth. An early diagnosis can help your child get the treatment they need as soon as possible.

Q1: How old is your child?

0-2 Months

3-4 Months

5-6 Months

7-9 Months

10-12 Months

13-18 Months

19-23 Months

24+ Months

0-2 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Hold their head steadily on their own?
  • Q3: Push themselves up when they are lying on their stomach?
  • Q4: Start to make smoother movements with their arms and legs?
  • Q5: Smile at other people?
  • Q6: Bring their hands to their mouth?
  • Q7: Turn their head when they hear a noise?
  • Q8: Coo or make gurgling noises?
  • Q9: Follow things with their eyes?
  • Q10: Try to look at their parents or caregivers?
  • Q11: Show boredom, cry, or fuss when engaged in an activity that hasn’t changed in awhile?
BACKBACK0-2-years old child

3-4 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Hold their head steadily on their own?
  • Q3: Push down on their legs when their feet are on a flat surface?
  • Q4: Start to roll over from their stomach to their back?
  • Q5: Hold and shake a toy such as a rattle?
  • Q6: Bring their hands to their mouth?
  • Q7: Play with people and start to cry when the playing stops?
  • Q8: Smile spontaneously, especially at people?
  • Q9: Copy some movements and facial expressions of other people?
  • Q10: Babbles with expressions and copy sounds they hear?
  • Q11: Cries in different ways to show hunger, pain, or being tired?
  • Q12: Respond to affection like hugging or kissing?
  • Q13: Follows moving things with eyes from side to side?
  • Q14: Recognize familiar people at a distance?
BACKBACK3-4-years old child

5-6 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Roll over on both sides (front to back/back to front)?
  • Q3: Begin to sit without support?
  • Q4: Rock back and forth?
  • Q5: Supports weight on legs and might bounce when standing?
  • Q6: Begin to pass things from one hand to another?
  • Q7: Bring objects such as toys to their mouth?
  • Q8: Know if someone is not familiar to them and is a stranger?
  • Q9: Respond to other people’s emotions such as a smile or a frown?
  • Q10: Enjoy looking at themselves in the mirror?
  • Q11: Look at things around them?
  • Q12: Respond to sounds they hear by making sounds themselves?
  • Q13: Make sounds to show joy or displeasure?
  • Q14: Respond to their own name?
  • Q15: Start to string vowels together such as "ah," "eh," "oh," or say consonant sounds such as "m" or "b"?
  • Q16: Begin to laugh?
BACKBACK5-6-years old child

7-9 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Crawl?
  • Q3: Stand while holding onto something to support them?
  • Q4: Sit without support?
  • Q5: Pull themselves up to stand?
  • Q6: Play peek-a-boo?
  • Q7: Move things from one hand to another?
  • Q8: Pick small things up such as a piece of cereal with their thumb and index finger?
  • Q9: Look for things that they see you hide?
  • Q10: Watch the path of something as it falls?
  • Q11: Show fear over being around strangers?
  • Q12: Become clingy with adults familiar to them?
  • Q13: Have favorite toys?
  • Q14: Use their fingers to point?
  • Q15: Understand “no?”
  • Q16: Make a lot of repetitive sounds such as “mamama” or “bababa”?
  • Q17: Copy sounds and gestures of other people?
BACKBACK7-9 years old child

10-12 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Stand alone with no support?
  • Q3: Walk while holding onto furniture?
  • Q4: Take a few steps without holding onto anything?
  • Q5: Get into a sitting position without any help?
  • Q6: Bang two things together when playing?
  • Q7: Poke with their index finger?
  • Q8: Start to use things like hair brushes or drinking cups correctly?
  • Q9: Find hidden objects easily?
  • Q10: Play peek-a-boo or pat-a-cake?
  • Q11: Become shy or nervous around strangers?
  • Q12: Repeat actions or sounds to get attention?
  • Q13: Puts out an arm or leg to help when getting dressed?
  • Q14: Cry when a parent leaves the room?
  • Q15: Show that they have favorite things or people?
  • Q16: Show fear?
  • Q17: Say things such as “mama,” “dada,” or “uh-oh”?
  • Q18: Try to say the words you say?
  • Q19: Start to use gestures like waving or shaking head “no”?
BACKBACK10-12 years old child

13-18 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Walk by themselves?
  • Q3: Walk up stairs and run?
  • Q4: Pulls toys while walking?
  • Q5: Drink from a cup on their own?
  • Q6: Eat with a spoon on their own?
  • Q7: Can help undress themselves?
  • Q8: Have occasional temper tantrums?
  • Q9: Show affection to familiar people?
  • Q10: Become clingy in new situations?
  • Q11: Explore their environment alone with parents close by?
  • Q12: Say several single words?
  • Q13: Say and shake their head “no”?
  • Q14: Point to show things to other people?
  • Q15: Scribble?
  • Q16: Know what ordinary products such as phones, spoons, and brushes are used for?
  • Q17: Follow 1-step commands such as “sit down” or “stand up”?
  • Q18: Plays with a doll or stuffed animal by pretending to feed them?
BACKBACK13-18 years old child

19-23 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Begin to run?
  • Q3: Kick a ball?
  • Q4: Climb down and onto furniture on their own?
  • Q5: Walk up and down stairs while holding on?
  • Q6: Stand on their tiptoes?
  • Q7: Throw a ball overhand?
  • Q8: Copy others, especially people older than them?
  • Q9: Get excited around other children?
  • Q10: Show more independence as they age?
  • Q11: Do what they were told not to do and become defiant?
  • Q12: Point to things when they are named?
  • Q13: Know names of familiar people or body parts?
  • Q14: Say 2 to 4-word sentences?
  • Q15: Repeat words they hear?
  • Q16: Complete sentences and rhymes in familiar books?
  • Q17: Name items in books such as dogs, cats, birds, etc.?
  • Q18: Play simple pretend games?
  • Q19: Start to use one hand more than the other?
  • Q20: Begin to sort shapes and colors?
  • Q21: Follow 2-step instructions such as “pick up your hat and put it on your head?”
BACKBACK19-23 years old child

24+ MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Run easily?
  • Q3: Climb?
  • Q4: Walk up and down stairs with one foot on each step?
  • Q5: Dress and undress themselves?
  • Q6: Show affection for friends without being told?
  • Q7: Take turns when playing games?
  • Q8: Show concern when others are crying?
  • Q9: Understand the idea of “mine,” “his,” or “hers”?
  • Q10: Show many different emotions?
  • Q11: Copy adults and friends?
  • Q12: Separate easily from their parents?
  • Q13: Get upset when there is a major change in their routine?
  • Q14: Say words such as “I,” “me,” “we,” “you,” and some plural nouns?
  • Q15: Say their first name, age, and gender?
  • Q16: Carry on a conversation with 2 to 3 sentences?
  • Q17: Work toys with buttons and other moving parts?
  • Q18: Play pretend with dolls, animals, or people?
  • Q19: Finish 3 or 4 piece puzzles?
  • Q20: Copy a circle when drawing?
  • Q21: Turn pages of a book one page at a time?
  • Q22: Turn door handles?
BACKBACK24 months + old child

Surgery for Erb’s Palsy

Some children with more severe cases of Erb’s palsy may require surgery alongside physical and occupational therapy to repair damaged nerves.

The goal of brachial plexus birth palsy surgery is to regain range of motion and control of the affected shoulder, upper arm, wrist, and/or hand. There are several different surgery options depending on the child’s needs.

Typically, surgical treatment for children under the age of 5 involves methods such as muscle lengthening, muscle transfers, nerve transfers, nerve grafts, nerve reconstruction or reconnection, and bone remodeling. Surgery for children over the age of 7 usually involves bone remodeling.

In very severe cases of Erb’s palsy that affects the hand, some doctors may recommend microsurgical neurolysis. However, this treatment is considered controversial and may not help a patient recover hand function.

Although surgery is successful for most patients with severe cases of Erb’s palsy, it can take several months for a child to regain full control of the muscles in their arm and lower hand.

During this time, doctors will recommend the child continue physical therapy and medical evaluation.

Prognosis After Erb’s Palsy Treatment

Treatment for an Erb’s palsy nerve injury varies based on the severity of the condition. Fortunately, children diagnosed with Erb’s palsy have a great chance of complete recovery.

The majority of children with Erb’s palsy will regain full control of their arm through physical therapy. Only a small percentage of children will require surgery, and an even smaller percentage will have lifelong symptoms.

The American Academy of Orthopedic Surgeons (AAOS) recommends frequent medical checkups for a baby with Erb’s palsy to determine if the nerves are healing. It may take up to two years for symptoms to lessen. The AAOS also states that daily physical therapy is the basis of Erb’s palsy treatment.

After Erb’s palsy has been diagnosed, it is key to start treatment as quickly as possible to increase your child’s chances of a full recovery.

Get Help Paying For Erb’s Palsy Treatment Today

Healthcare professionals have a duty to safely deliver babies even during emergency birthing situations. However, Erb’s palsy is often caused by preventable injuries during childbirth.

Many children with Erb’s palsy can make a full recovery with prompt treatment. If your child’s condition was caused by medical negligence, you should not be responsible for paying for their treatment.

Your family may be eligible for financial compensation if your child’s injury was preventable. This compensation can help cover your child’s medical costs and Erb’s palsy treatment.

To learn more about taking legal action, get a free case review.

Erb’s Palsy Treatment FAQs

What causes Erb’s palsy?

Erb’s palsy (also called Erb-Duchenne palsy) is caused by using excessive force while pulling or twisting on the child’s arm, shoulder, or neck when exiting the birth canal.

There are several risk factors that can lead to Erb’s palsy such as the fetus being in a breech position (legs first), shoulder dystocia (one or both shoulders stuck in birth canal), and more.

Can Erb's palsy be fixed?

Many children are able to make a partial or full recovery from Erb’s palsy with prompt treatment.

According to the AAOS, about 80% of children with Erb’s palsy make a full recovery with treatment.

What are common Erb’s palsy treatment methods?

Most cases of Erb’s palsy are treated with physical therapy that focuses on regaining muscle control and strength.

More severe cases of Erb’s palsy may be treated with a combination of physical therapy and surgery.

What happens if Erb's Palsy is left untreated?

Nerve damage and Erb’s palsy symptoms could worsen if the condition is left untreated. This may result in permanent brachial plexus damage which can greatly affect the child’s motor skills and quality of life.

It is critical to seek Erb’s palsy treatment as soon as your child is diagnosed with the condition to give them the best chance at fully recovering.

Birth Injury Support Team

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 7 Sources
  1. Chater, M., Camfield, P., & Camfield, C. (2004, October). Erb's palsy - who is to blame and what will happen? Paediatrics & child health. Retrieved March 25, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724163/#b31-pch09556
  2. Davidge, K. M., Clarke, H. M., & Borschel, G. H. (2016, April 16). Nerve transfers in birth related brachial plexus injuries: Where do we stand? Hand Clinics. Retrieved March 25, 2022, from https://www.sciencedirect.com/science/article/pii/S0749071215001572?via%3Dihub
  3. Erb's palsy (brachial plexus birth palsy) - orthoinfo - AAOS. OrthoInfo. (n.d.). Retrieved March 25, 2022, from https://orthoinfo.aaos.org/en/diseases--conditions/erbs-palsy-brachial-plexus-birth-palsy
  4. Mayo Foundation for Medical Education and Research. (2020, April 15). Brachial plexus injury. Mayo Clinic. Retrieved March 25, 2022, from http://www.mayoclinic.org/diseases-conditions/brachial-plexus-injury/symptoms-causes/syc-20350235.
  5. Midha, R., & Drake, J. M. (2005, February). Nerve transfers in severe obstetrical brachial plexus palsy. Seminars in Plastic Surgery. Retrieved March 25, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884742/
  6. Nerve conduction studies. Johns Hopkins Medicine. (n.d.). Retrieved March 25, 2022, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/nerve-conduction-studies#:~:text=A%20nerve%20conduction%20velocity%20
  7. NHS. (n.d.). Surgery. NHS choices. Retrieved March 25, 2022, from http://www.leedsth.nhs.uk/a-z-of-services/erbs-palsy/your-condition-and-treatment/surgery/
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