Erb’s Palsy Overview

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Erb’s palsy is a condition most often caused during childbirth because of injury to certain nerves. This injury causes muscle weakness and paralysis in one arm. Many children recover, but not all will and some will have to live with the damage for life.

What is Erb’s Palsy?

Erb’s palsy is a type of palsy or weakness or paralysis of muscles. This occurs sometimes in infants due to injuries to nerves during childbirth. It is also sometimes called brachial plexus palsy, after the name of the bundle of nerves damaged.

Erb’s palsy is characterized by paralysis, weakness, or loss of movement of the arm at birth. The condition improves or completely goes away for most infants, but some have permanent complications.

The Brachial Plexus

The bundle of nerves that can be damaged and cause Erb’s palsy are called the brachial plexus. [1] This network of nerves runs from the spine, through the bones of the neck, down either side and out to the arm. These nerves allow the arm, hand, and fingers to move and give them sensation. The nerves that run lower provide movement and sensation to the hands and fingers, and those that are higher go to the shoulder.

Erb’s palsy typically affects both the lower and upper arm. Some injuries that occur higher up in the brachial plexus only affect the upper arm and shoulder, while those occurring lower down affect the hand. This latter type of injury is sometimes called Klumpke palsy or paralysis. [2]

Symptoms of Erb’s Palsy

The injury that causes Erb’s palsy occurs at childbirth. The signs of damage or injury include a lack of reflexes on the affected side, no movement in the arm or a part of the arm, minimal grip strength in the affected hand, and an arm bent at the elbow and held tightly to the side of the infant. [3]

If somehow the condition is not detected until later, the child may experience weakness, loss of feeling, or partial or total paralysis in the arm.

Types of Injuries to the Brachial Plexus

The severity of the symptoms seen in a child with Erb’s palsy depends on the extent of the injury to the brachial plexus. The most common type of injury seen is called neurapraxia. This means that the nerves have been stretched too far and shocked, but not torn or damaged.  In infants, recovery occurs usually within three months.

A neuroma injury is when the nerves have been stretched enough to cause some damage. This can lead to the formation of scar tissue that presses on healthy nerves. Infants with a neuroma may take longer to recover, but most still do. A rupture occurs when some of the nerves tear and cannot heal on their own.

The most severe injury to the brachial plexus is called an avulsion. This means the nerves have been torn and separated from the spinal cord. Both ruptures and avulsions are serious. Some repair may be possible through surgery, but full recovery is not likely.

Causes of Erb’s Palsy

The overwhelmingly most common cause of Erb’s palsy in infants is difficult childbirth. The damage is more likely to occur if the child is unusually large, the birth is breech, or labor goes on for a long time. [4]

The injury is caused by pulling on the shoulders of the infant comes out head first, pressure on the arms in a breech position, or pulling to the side of the infant’s head as it comes out of the birth canal.

Sometimes the injury is unexpected and unavoidable. The doctor or midwife may pull too hard or in one direction too much and cause the injury to the brachial plexus. This is most likely to occur if the delivery is complicated and long or if the head has already emerged and the shoulder comes out only with difficulty.

Treatment

Fortunately, for most children born with Erb’s palsy, recovery occurs within three to six months. The recovery of damaged nerves is slow but possible for many infants. Most children with this condition will receive physical therapy to help stimulate healing and to prevent permanent stiffness in the joints of the arm.

In more severe cases of Erb’s palsy, surgical treatments may be necessary. For torn nerves, a graft using a donor’s nerve may be possible and can restore feeling and movement. A full replacement of a nerve with a donor’s nerve may also work, but these are complicated surgeries and they are not always successful at restoring complete movement and sensation. [5]

Nerve surgery is not done until the infant is at least six months if the nerves are not healing.