Surgery for Erb’s Palsy

Quick Answer

Surgery for Erb’s palsy is recommended in severe cases when physical therapy is not an effective treatment. Erb’s palsy surgery aims to repair the nerves that are causing a lack of function in a child’s arm. Although some children experience lasting arm weakness and movement limitations, surgery for Erb’s palsy is often very successful.

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Surgery for Erb’s Palsy Explained

Erb’s palsy is a condition that stems from a birth injury. It causes partial or complete paralysis of a child’s arm from nerve damage.

Erb’s palsy is caused by damage to specific nerves in the shoulder that are responsible for:

  • Rotating shoulders
  • Bending elbows
  • Moving fingers

Doctors will recommend surgery for the condition if a child isn’t showing improvement in their symptoms after 3 to 6 months of physical therapy or earlier in more severe cases.

Ideally, Erb’s palsy surgery should be done before the child is 18 months old. Muscles that are disconnected from nerves for longer than this may become too weak to recover.

10% to 30% of Erb’s palsy cases require surgery to restore function to a child’s arm. During surgery, a neurosurgeon will perform a special operation to help the damaged nerves reconnect to the paralyzed arm muscles.

What Is Surgery for Erb’s Palsy?

During Erb’s palsy surgery, a neurologist transfers or grafts part of a healthy nerve to the affected area from another part of the child’s body. Doctors then reconnect the damaged nerve fibers to the muscles. A less invasive form of surgery involves reducing the pressure on damaged nerves to encourage healing.

Following surgery, it may take quite some time for the nerves to regrow and reach all the way to the muscles in your child’s arm. Months to a year may pass before you see any signs of improvement following surgery. Fortunately, you can encourage a successful recovery by enrolling your child in physical and occupational therapy.

What Are the Goals of Surgery for Erb’s Palsy?

Although milder cases of Erb’s palsy tend to heal on their own, severe cases can leave permanent damage if left untreated. Surgery is the only option when physical therapy is not enough.

The goal with surgery for Erb’s palsy is to help the child regain arm, elbow and shoulder function. Surgery can help them can enjoy a high quality of life and complete daily tasks with ease.

Since the nervous system of a baby is new and easily molded, nerve transfers at this age have a good chance of success. Around 81% of children who receive surgery for Erb’s palsy will show a significant improvement.

However, surgery is not always totally effective. Many children still experience weakness in their arm, hand or shoulder as they continue to grow. Your doctor may recommend more surgeries when your child is older to improve functionality and range of motion.

Surgical Procedures for Erb’s Palsy

Depending on your child’s specific condition, there are a variety of surgical options that doctors may recommend to you. These include nerve grafting and nerve decompression surgeries.

Nerve Grafting Surgery

Nerve grafting surgery is possible if the damaged nerve is still attached to the spinal cord. The nerve is repaired using a portion of a donor nerve taken from somewhere else in the child’s body. You can think of this as a kind of bridge over which the nerve can regrow and reach the muscles that it should control.

Your child’s surgeon will choose a donor nerve that is much less important than the one they are repairing. Often, this is a nerve in the back of the leg that creates a sensation on the side of the foot. Removing this nerve will create a small numb patch on your child’s foot that may reduce in size over time.

Nerve grafting surgery is not possible if the roots of the nerve are entirely detached from the spinal cord. In this case, the neurosurgeon will transfer other nerves from the spinal cord to the most important muscles involved in arm function.

When your child is older, doctors may recommend tendon transfer surgeries to release tight muscles or strengthen weak ones.

Nerve Decompression Surgery

Some cases of Erb’s palsy are the result of pressure on the nerve fibers. Nerve decompression is a minimally invasive surgery that reduces this pressure and gives the damaged nerve room to repair itself naturally.

The surgeon will make a small incision in the neck and use a special tool to decompress the damaged nerve. Although this type of surgery is not as effective as a nerve grafting procedure, it can help restore function to a mildly damaged nerve.

What to Expect With Surgery for Erb’s Palsy

Surgery for Erb’s palsy is a complicated procedure and can last up to 12 hours. Because of this, doctors take precautions to protect the child during surgery, positioning them comfortably and protecting their pressure points. Neurosurgeons are also very careful to avoid damaging nearby nerve structures, though there is still a small risk that this could happen.

The surgery is done using general anesthetics (to create a sleep-like state) and focuses on a small area near the base of the neck. If the surgeon is grafting a nerve from your child’s leg for the procedure, they will make 2 or 3 tiny, horizontal incisions along the back of the leg. Only minimal scarring will be visible.

Following the surgery, doctors will bandage your child’s arm and provide a sling or shoulder cast to limit movement. Your child will need to remain in the hospital for 2 to 4 days following surgery and wear their cast for 4 to 6 weeks while the nerves begin healing.

Recovery and Therapy After Erb’s Palsy Surgery

About 4 weeks after surgery, patients are referred back to a physical therapist. Ongoing physical and occupational therapy will help your child master movement of their arm and work on the skills they need for daily activities.

Physical and occupational therapies exercises for Erb’s palsy seek to:

  • Improve range of motion and flexibility
  • Strengthen weak muscles
  • Reduce muscle stiffness
  • Stimulate sensation in the arm

Your physical therapist will teach you some home exercises to continue with your baby to help them rehabilitate following surgery. In general, try to get your child to use both of their hands when playing.

It can take 3 months to notice improvement after surgery and full recovery can take up to 4 years. In some cases, children experience permanent shoulder rotation difficulties and arm weakness.

Financial Compensation for Surgery for Erb’s Palsy

Erb’s palsy is often the result of a complicated or difficult birth. Trauma to the baby’s neck during delivery can severely stretch or rupture nerves or tear them away from the spine.

Erb’s palsy is most common when the baby is delivered in a breech position and doctors use extra force to remove the baby. When this happens, Erb’s palsy may be the fault of the doctors or medical providers.

If medical negligence played a role in your child’s birth injury, you may be able to claim financial compensation. This can help you pay for expensive surgeries, therapy and treatments.

To learn more about filing a medical malpractice claim, work with an attorney who has experience with Erb’s palsy cases. Contact the Birth Injury Justice Center today at 800-914-1562 and get a free medical case review.

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 Sources
  1. “Erb’s Palsy (Brachial Plexus Birth Palsy)” American Academy of Orthopaedic Surgeons. Retrieved from Accessed on December 12, 2018.
  2. “Surgery” The Leads Teaching Hospitals. Retrieved from Accessed on December 12, 2018.
  3. “Nerve Transfers in Birth Related Brachial Plexus Injuries: Where Do We Stand?” Hand Clinics. Retrieved from Accessed on December 12, 2018.
  4. “Nerve Transfers in Severe Obstetrical Brachial Plexus Palsy” Seminars in Plastic Surgery. Retrieved from Accessed on December 12, 2018.
  5. “Erb’s palsy – Who is to blame and what will happen?” Paediatrics & Child Health. Retrieved from Accessed on December 12, 2018.
  6. “Erb’s Palsy” ScienceDirect. Retrieved from Accessed on December 12, 2018.