Most common in newborns, Erb’s palsy is a condition caused by damage to the nerves that control the shoulder and arm. This bundle of nerves, called the brachial plexus, connects the spinal cord to the shoulder, arm, and hands, and provides sensation and movement control. When those nerves get damaged, which in the majority of cases occurs during childbirth, movement and sensation can become impaired.
The symptoms of Erb’s palsy vary depending on the extent of the damage, but also on which nerves within the brachial plexus were damaged. Different nerves control different parts of the arm, so in one case the hand may be affected, while in another it is the shoulder. The damage also varies in intensity. The greater the damage, the more severe the symptoms are. Fortunately, most damage that causes Erb’s palsy is temporary and these are not symptoms most children have to live with forever.
Symptoms Are Immediate
Since the damage that causes Erb’s palsy usually occurs during birth, the results are often seen immediately. This means that treatment can begin right away and give a child the best prognosis.
Medical caregivers should be able to see signs of the condition immediately, in some cases simply by observing the child’s movements. Even if the signs are not obviously apparent just by watching the baby, simple tests, like standard reflex tests and a standard physical exam will most likely uncover signs of Erb’s palsy if damage occurred during birth.
Lack of Movement
One of the first symptoms that a doctor or new mother may detect in an infant is a lack of movement in the affected arm. Although motor control is limited in a newborn, infants do move their arms around right after birth.
If one arm is moving and the other one isn’t, it is likely a sign of Erb’s palsy. The lack of movement may be mild or severe, ranging from no movement at all to limited range of motion in the shoulder.
Babies should be born with certain inherent reflexes, and poor reflexes or a complete lack of reflexes in one arm or shoulder may be a symptom of Erb’s palsy. An easy way to test for reflexes is to test for the moro reflex, a response to stimulation that should be present immediately after birth and that disappears at three to four months of age.
To test the moro reflex, the baby is placed on its back. The head is gently lifted and supported as the weight of the body begins to lift from the surface on which the baby is lying.
The head is then quickly released, and of course caught again by a supporting hand. The baby should appear startled during this maneuver, while also moving its arms to the side with palms up and flexed thumbs. This is called the moro reflex. A lack of this reflex on one side is often a sign of Erb’s palsy.
Bending the Arm Awkwardly
Another symptom of Erb’s palsy often seen in newborns is an awkward placement of the affected arm. The baby may have its arm bent toward its side, which does not look normal. This bending toward the body is most typical, but any placement of the arm that seems unnatural could indicate Erb’s palsy.
The baby is placing its arm in whatever position feels most comfortable due to damage to the brachial plexus.
Poor Grip Strength
Damage to the brachial plexus sometimes affects a baby’s ability to grip objects. If you place something in a baby’s hand, like your finger, it should be able to grip it. A symptom of Erb’s palsy is a grip in one hand with no grip, or a noticeably weaker grip in the other. This is a fairly simple test and one that can quickly indicate a child has had nerve damage.
Pain or Loss of Sensation
A newborn cannot tell you that it has no feeling in one arm or that it is in pain, but these are potential symptoms of Erb’s palsy. This is why it is important to find other, more noticeable symptoms so that the condition can be treated.
A newborn may be suffering from pain in the arm, but cannot easily communicate that. A baby with pain in its arm may cry or scream more, but it is not always easy to distinguish this from normal crying.
Symptoms of Brachial Plexus Injuries in Adults and Children
Most cases of Erb’s palsy are in newborns due to accidents in childbirth. However, this condition can occur in anyone of any age due to damage caused by injuries or accidents. Car accidents, sports injuries, and even tumors can cause damage to the brachial plexus.
Symptoms of this may include a burning sensation like an electric shock that passes down the arm, weakness or numbness in the arm, paralysis in the arm, or pain in the arm.
Any symptoms of Erb’s palsy or brachial plexus injury should be taken seriously. Newborns mostly recover well from this condition, but even if treatment isn’t needed, physical therapy can help a baby heal faster and feel more comfortable. If you see signs in your child that seem like Erb’s palsy, talk to your doctor about it right away.