Erb’s Palsy Treatment

Fact Checked

Erb’s palsy is caused by nerve damage in newborns that causes weakness and paralysis in the arm.[1] Erb’s palsy treatments include physical therapy, surgery, medications, and occupational therapy. Not all babies need treatment and recover within a few months.

Natural Recovery from Erb’s Palsy

During the delivery process, there is always a risk that the brachial plexus nerves will overstretch in an infant. These are the nerves running along the neck that control the arms and hands.

The risk is more significant for breech births, large babies, and those with shoulder dystocia or otherwise difficult and prolonged labor.

The nerves may stretch just a little bit, causing stress; they may stretch enough to cause some damage or even stretch to the extent that they are torn away or separated from the spinal column.

Fortunately, the majority of cases of Erb’s palsy involve minimal damage to the nerves with little to no treatment needed.

For these newborns, a few months, possibly up to nine months, is all it takes for the nerves to heal naturally. Most infants with this condition have a good prognosis and do not need treatment.

Time and moderate use of the affected arm is enough to facilitate the healing of the nerves and restore normal movement and sensation. For those who experience more considerable nerve damage, treatments can help.

Physical and Occupational Therapy

The most commonly prescribed 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 optimize the chance that the child will achieve full use of the arm.[2]

Occupational therapy focuses on using fine motor muscles and feeding, which can greatly assist in recovery. Babies get the best results from both physical and occupational therapy for Erb’s palsy when started as early as possible.

The exercises used for an infant with Erb’s palsy are very mild and gentle. Those most commonly recommended include gentle massage, strength exercises, range of motion movements, stimulation exercises, and gentle stretching.

Therapists demonstrate methods by which parents can encourage their infant to move the affected arm naturally, allowing for a more active form of therapy.

Sessions should be conducted with a professional pediatric physical therapist, and parents are instructed on how to continue these exercises at home for the best overall result.

Another aspect of physical therapy is using splints, braces, and tape to promote proper alignment of joints and train the infant’s arm, wrist, shoulder, and hand to position and move in the anatomically correct ways that promote healing. These devices may also help prevent deformities resulting from improper positioning.

Recreational Therapy

Recreation should be encouraged as an infant with Erb’s palsy grows and develops. Parents may be afraid to let a child that has experienced nerve damage and paralysis engage in activities. However, most types of recreational activities, movement, and exercise are beneficial.

Any child growing and healing from Erb’s palsy should be encouraged to try recreational activities that promote arm and shoulder movement, including climbing, crawling, swimming, wheelbarrow walking, and throwing.

Surgery

If a child with Erb’s palsy shows no signs of healing by about six months of age, or if the healing process 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.[3]

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 connected to the spinal cord, a graft from a donor nerve can be attached to it to repair it. A complete nerve transfer is performed when a nerve has been completely detached from the spinal cord.

In cases where 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 full use or sensation in the affected arm.[4]

Neuromuscular Electrical Stimulation

In addition to the more traditional treatments for Erb’s palsy—surgery and physical therapy—some other strategies may help. One of these is neuromuscular electrical stimulation, stimulating muscles in the affected arm with an electrical current.

It has been shown to build muscle and improve blood flow in babies, but there are only a few studies of the technique. This type of treatment may also be useful in minimizing the eventual weakening of muscles that a child with Erb’s palsy is unable to use naturally.

Botox Therapy

Botox is botulinum toxin A, a medication made from a highly toxic substance produced by a type of bacterium. Botox temporarily paralyzes 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.

For a child with Erb’s palsy, Botox has been used to improve shoulder flexibility. It has also been employed to paralyze functional muscles in the arm. Botox in one muscle gives the other weaker muscles the chance to develop.

Studies into the effectiveness of this treatment are limited, but one showed that the children receiving Botox injections had improved range of motion in the shoulder and elbow joints. For some of the children in the study, planned surgeries were postponed due to the success of Botox treatment.

If you have an infant with Erb’s palsy, many treatment options are available. Luckily, most babies will only ever need physical therapy to recover the full use of the arm.

For those that have experienced more damage, however, surgery and 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 different options and make the best, most informed decision for your child.