Erb’s Palsy Overview

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Erb’s palsy is paralysis and weakness in the arm resulting from damage to the brachial plexus nerves. This damage often occurs during childbirth, leaving a baby with a disability that may be permanent. The prognosis is good for most babies, but some live with lifelong disabilities, even with treatment.

What Is Erb’s Palsy?

Erb’s palsy is a type of palsy, a weakness or paralysis of muscles. This sometimes occurs 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 causes paralysis, weakness, or lack of arm movement at birth. The condition improves or completely goes away for most infants, but some have permanent complications and disabilities.

What Is the Brachial Plexus?

The brachial plexus is the bundle of nerves that can be damaged and cause Erb’s palsy.[1] Brachial plexus nerves run from the spine, through the bones of the neck, down either side, and to the arms.

The brachial plexus 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 arms. 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 or Klumpke’s palsy.[2]

What Are the Symptoms of Erb’s Palsy?

The injury that causes Erb’s palsy occurs during childbirth. The signs of damage or injury include:[3]

• 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
• An arm bent at the elbow and held tightly to the side of the infant

If doctors don’t detect the condition 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.[4]

The least severe type of injury is called neurapraxia. This means the nerves have been stretched too far and shocked but not torn or damaged. In infants, recovery usually occurs within three months.

A neuroma injury is when the nerves have been stretched enough to cause some damage. This can lead to 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 independently.

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 severe. Some surgical repair might help but is unlikely to lead to complete recovery.

Causes of Erb’s Palsy

The most common cause of Erb’s palsy in infants is difficult childbirth. The damage is more likely if the child is unusually large, the birth is breech, or labor goes on for a long time.[5]

The injury is caused by pulling on the shoulders of the infant emerging head first, pressure on the arms in a breech position, or pulling to the side of the infant’s head as it emerges from 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 damage to the brachial plexus.

This is most likely to occur if the delivery is complicated and lengthy or if the head has already emerged and the shoulder comes out only with difficulty.

How Is Erb’s Palsy Treated?

Fortunately, recovery occurs within three to six months for most children born with Erb’s palsy. 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 prevent permanent stiffness in the arm’s joints.

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.

Surgeons may also perform a nerve transfer, redirecting nerves to restore function. These are complicated surgeries, and it can take months or even years to see restoration of movement and sensation.[6]

What Is the Prognosis for Erb’s Palsy?

For most children born with Erb’s palsy, the prognosis is favorable. The damage is usually mild. Quick interventions restore normal function within a year for many babies.

Babies with more severe injuries or with delayed treatment have a poorer prognosis. If there are no interventions, the disability becomes irreversible around 18 to 24 months of age.[6]

If your child has Erb’s palsy, contact a birth injury lawyer. They can determine if medical malpractice caused the condition and help you recover damages for your child.