Erb’s palsy is a condition caused by nerve damage and it most often occurs in newborns. The damage is to the brachial plexus, the bundle of nerves that runs from the spinal cord, through the neck, and down each arm. These nerves are responsible for movement and sensation throughout the shoulder, arm, hand, and fingers, and when damaged can lead to weakness or total paralysis. The amount of paralysis varies depending on the extent of the damage.
This damage most often occurs in newborns because it happens during childbirth. Most babies will recover within a few months with no intervention or with moderate physical therapy. More severe damage may require more extensive treatment ranging from various types of physical therapy to surgery. Some children will recover all movement and feeling, while a few will never fully recover in spite of treatment.
Recovery without Treatment
During labor there is always a risk that the brachial plexus nerves will be overstretched in an infant. The risk is greater for breech births, large babies, and labors that go on for a long period of time or are otherwise difficult. The nerves may stretch just a little bit, causing stress; they may stretch enough to cause some damage, they may even stretch to the extent that they are torn or completely separated from the spinal column.
Fortunately, the majority of cases of Erb’s palsy involve minimal damage to the nerves. For these newborns, a few months, possibly up to nine months, is all it takes for the nerves to heal. Most children with this condition will not need treatment. Time and moderate use of the affected arm is enough to heal the nerves and restore normal movement and sensation. For those who experience greater nerve damage, there are treatment options that can help.
The most common treatment for Erb’s palsy is physical therapy. Even for infants with minor damage to the brachial plexus, this kind of therapy is recommended to speed healing and to optimize the odds that the child will get full use of the arm. The best results from physical therapy for Erb’s palsy come from starting it as early as possible.
The exercises used for an infant with Erb’s palsy are very mild and gentle. The kinds of exercises that are commonly used include gentle massage, strength exercises, range of motion exercises, stimulation exercises, and gentle stretching.
Since an infant cannot do these exercises, of course, an adult must move the arm for the baby. Sessions should be conducted with a professional pediatric physical therapist, but parents are instructed on how to continue these exercises at home.
Another aspect of physical therapy is the use of splints, braces, and tape to promote proper alignment of joints and to train the infant’s arm, wrist, shoulder, and hand to move in the correct ways that promote healing. These devices can also reduce pain for an infant, prevent deformities, and even help with proper movement.
As an infant with Erb’s palsy grows and develops, recreation should be encouraged. Parents may be afraid to let a child that has experienced nerve damage and paralysis engage in activities. However, most types of recreation, movement, and exercise have positive benefits.
Any child growing and healing from Erb’s palsy should be encouraged to try recreational activities that involve movement of the arm and shoulder: climbing, crawling, swimming, wheelbarrow walking, and throwing, for instance.
If a child with Erb’s palsy shows no signs of healing by about six months of age, or if the healing is too slow or inadequate, surgery may be an option to restore movement and feeling. The purpose of surgery is to repair the damage done to the nerves of the brachial plexus or to relieve pressure on the nerves so they have a better chance of healing naturally.
The latter type of surgery is minimally invasive and can be done for a child of any age. It relieves pressure placed on damaged nerves and promotes healing. The effectiveness of this strategy varies.
More aggressive types of surgery attempt to actually repair or replace the damaged nerves using donor nerves. If there is a tear in a nerve, but it is still attached the spinal cord, a graft from a donor nerve can be attached to it to make the repair. A complete nerve transfer is done when a nerve has been completely detached from the spinal cord.
After these types of surgeries, a child needs extensive physical therapy and a lot of recovery time. In cases in which Erb’s palsy is severe enough to warrant surgery, complete recovery is not likely. Most children having this kind of surgery will see improvements, but may never have complete use or sensation in the affected arm.
Neuromuscular Electrical Stimulation
In addition to the more traditional treatments for Erb’s palsy—surgery and physical therapy—there are some other strategies that may help. One of these is neuromuscular electrical stimulation. This involves stimulating muscles in the affected arm with electrical current. It has been shown to build muscle and improve blood flow in babies, but study of the technique is minimal. This type of treatment may also be useful in minimizing atrophy of muscles that a child with Erb’s palsy cannot use naturally.
Botox is botulinum toxin A, a medication made from a highly toxic substance produced by a type of bacterium. The injections of Botox are used for a variety of medical and cosmetic reasons and work by temporarily paralyzing muscles at the site of injection. Because the injections are localized, there is little risk of the toxin spreading to other parts of the body and causing a dangerous infection.
For a child with Erb’s palsy, Botox has been used to improve shoulder flexibility. It has also been used to paralyze functional muscles in the arm, which gives other muscles that are weaker the chance to develop.
Studies into the effectiveness of this treatment are limited, but one showed that children receiving it had improved range of motion in the shoulder and elbow. For some of the children in the study, planned surgeries were postponed because of the success of the Botox treatment.
If you have an infant with Erb’s palsy there are many treatment options available. Luckily, most children will only ever need physical therapy to recover full use of the arm.
For those that have experienced more damage, though, surgery and other alternative treatments may help. There are always risks associated with these more aggressive treatments, but with your medical team you can learn more about the options and make the best, most-informed decision for your child.