Erb’s Palsy Signs and Symptoms

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Erb’s palsy is a common birth injury affecting the arm. Erb’s palsy symptoms include loss of sensation, muscle weakness, and, in some children, paralysis in the arm.[1] Symptoms of Erb’s palsy vary in severity and may be temporary or permanent.

What Are the Symptoms of Erb’s Palsy?

Erb’s palsy occurs when the brachial plexus nerves that control the arms are damaged. Symptoms of Erb’s palsy include:

• Weakness or paralysis in the arm, shoulder, or elbow joint
• Tingling and numbness in the arm or hand
• Reduced grip strength in the hand
• The palm of the hand curved backward, and fingers curled

What Are the First Symptoms of Erb’s Palsy?

Since the damage that causes Erb’s palsy usually occurs during birth, the results are often seen immediately. This means treatment can begin immediately to give a newborn the best prognosis.

Doctors and nurses should be able to see signs of Erb’s palsy in an infant after birth simply by observing the baby.

Even if they are not apparent just by watching the baby, standard reflex tests along with a routine physical exam will most likely uncover findings consistent with Erb’s palsy if the damage occurred during the birth process.[2]

Lack of Movement

One of the first signs a doctor or new parent may detect in an infant is a lack of movement or weakness in the affected arm. Although motor control is limited in newborns, infants move their arms around right after birth.

If one arm moves and the other does not, it is likely a sign of Erb’s palsy. The lack of movement may be mild or severe, ranging from merely a limited range of motion at the shoulder to no movement at all.

Poor Reflexes

Babies are born with certain inherent reflexes. A diminishment or loss of the normal reflexes in one arm may be a sign of Erb’s palsy.

An easy way to test for this is to check for the Moro reflex (or startle reflex), a natural response present immediately after birth, which disappears by three to four months of age.

To test the Moro reflex, the baby is placed on its back. The arms are gently lifted and then let go together. This gives the feeling of falling, and the baby should appear startled during this maneuver, extending the arms outward first, then to the front, and finally back again to the sides.[3]

This predictable movement is called the Moro reflex and should be symmetrical. Less movement on one side is often an indication of Erb’s palsy.

Positioning the Arm Abnormally

Another sign of Erb’s palsy, often seen in newborns, is an awkward positioning of the affected arm. The infant may hold its arm extended downward and rotated in toward the body, which does not look normal.

This abnormal positioning of the arm is readily apparent and most commonly seen in these cases, but any placement of the arm that seems unnatural could indicate Erb’s palsy.

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 grasp it and hold on pretty tightly.

A symptom of Erb’s palsy is a grip in one hand with a noticeably weaker or no grip in the other. This is a relatively simple test that can quickly indicate nerve damage.[4]

Loss of Sensation

A newborn cannot tell you they have no feeling in or cannot move one arm, but these are potential symptoms of Erb’s palsy. This is why finding other, more noticeable symptoms is essential so that the condition can be detected early and treated.

What Are the Long-Term Symptoms of Erb’s Palsy?

Most babies have a good prognosis and fully recover from the early symptoms of Erb’s palsy. More severe injuries or lack of treatment can lead to long-term symptoms or complications:

• Weakness and paralysis
• Stiff, tightened muscles and tendons
• Stiffness in the head and neck
• Atrophied muscles
• Numbness

What Are the Symptoms of Erb’s Palsy in Older Children or Adults?

Most cases of Erb’s palsy are seen in newborns and are generally due to difficulties associated with childbirth.

However, damage to any part of the brachial plexus can occur later in life from other types of 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, or pain. When the entire brachial plexus is injured, and not just the nerves involved in Erb’s palsy, the whole arm, including the wrist and hands, will be affected.

Any symptoms of Erb’s palsy or brachial plexus injury should be taken seriously. Most newborns recover well from this condition, but even if other forms of treatment are not needed, physical therapy can help a baby heal faster to regain normal movement. Talk to your doctor immediately if you see signs in your child that seem like Erb’s palsy.