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Raising Awareness - Erb's Palsy

Article and content created by © 2021 Birth Injury Justice Center

What Is Erb’s Palsy?

"Erb’s palsy, also called brachial plexus birth palsy or Erb-Duchenne palsy, is a condition caused by nerve damage around the time of birth.

Doctors or nurses pulling on a baby during a difficult delivery can damage the brachial plexus, or the network of nerves that sends signals from the spine to the shoulders, arms, and hands. The resulting condition, Erb’s palsy, prevents the baby from properly using their affected limb.

Erb’s palsy can cause difficulties in completing daily tasks, such as eating and getting dressed. Fortunately, the condition is highly treatable, and most children can achieve a complete recovery.

Types of Erb’s Palsy Injuries

The severity of a child’s condition depends on the type of nerve damage that occurs:

  • Neurapraxia: Stretching of the nerve without tearing

  • Neuroma: A stretch injury that may cause scar tissue

  • Rupture: Tearing of the nerve without separation from the spinal cord

  • Avulsion: The nerve root tears away from the spinal cord and will not heal on its own

Causes of Erb’s Palsy

One of the most common cause of Erb's Palsy is a condition called shoulder dystocia, which occurs when an infant’s shoulder is caught behind the mother’s pubic bone during childbirth. When a medical professional pulls on the baby to release their shoulder, it can stretch or tear the healthy nerves in that area.

Other situations that may cause Erb’s palsy:

  • The baby’s head and neck pulling sideways as they pass through the birth canal

  • Pulling the baby’s shoulders during a head-first delivery

  • Pulling on the baby’s feet during a feet-first (breech) delivery, which puts too much pressure on the infant’s arms

  • Shoulder dislocation or fractures in the collarbone (clavicle)

Symptoms of Erb’s Palsy

Notable signs of Erb’s palsy include:

  • Muscle weakness in one arm

  • Numbness or tingling in shoulder, arm, or hand

  • Unresponsive, limp arm or hand

  • Limited ability to grasp objects, or only using one hand to grasp objects

  • Partial or complete arm paralysis

  • Limited muscular or nerve development in the arm or hand

What symptoms develop will depend on the severity of the injury. In extreme cases, someone with Erb’s palsy may not be able to move their affected limb at all.

Diagnosis of Erb’s Palsy

If you suspect your child has Erb’s palsy, you should consult your doctor or pediatric physician. Only a medical expert can make an Erb’s palsy diagnosis.

  • Physical examination

  • MRI

  • CT scan

  • Nerve conduction study

Physical examinations look for outward signs of the condition. Electronic scans of the body, such as an MRI or CT scan, check to see if there has been nerve damage — and how bad the damage is.

Prognosis of Erb’s Palsy

Once your child has been diagnosed, your doctor will give you a prognosis, or the expected outlook of the condition. Erb’s palsy has a much better outlook than many other birth injuries.

According to a study conducted by Dalhousie University and the IWK Health Centre in Nova Scotia, 80% to 96% of newborns will completely recover from Erb’s palsy.

With prompt and proper therapy, mild cases of Erb’s palsy heal within a few months. However, severe cases may never fully heal, even with therapy and surgery. Catching Erb’s palsy as early as possible is the best way to ensure effective treatment.

Erb’s Palsy Treatment

Your child’s diagnosis and prognosis inform their Erb’s palsy treatment plan.

Stretched nerves may only require physical therapy, as they can often heal on their own with muscle conditioning. Torn nerves, however, may also require surgery. All Erb’s palsy treatments are intended to help your child to regain use of their affected shoulder, arm, and/or hand.

The key to recovery is starting treatment early. Treatment is most effective when it begins within the first four weeks after the child’s birth.

Most babies with Erb’s palsy will recover completely within 12 months of age with proper treatment.

Most cases of Erb’s palsy are mild and can heal with frequent physical therapy.

Physical therapy activities for Erb’s palsy include:

  • Stretching

  • Range-of-motion exercises

  • Sensory activities

The best type of physical therapy for your child depends on the issues they face. Stretches and range-of-motion exercises can improve a child’s control, while sensory activities can help to restore any lost feeling.

Other Therapies

In addition to physical therapy, your child may also benefit from other types of therapy to help their brachial plexus heal.

Other Erb’s palsy therapies include:

  • Hydrotherapy: Physical therapy in water to minimize stress on the body and allow your child to move through therapy with less pain

  • Occupational therapy: Usually needed after surgery to help patients improve on day-to-day tasks such as eating, playing, and drawing

  • Botulinum toxin injections: Botox injections are used to reduce contractures (tightening of the muscles, ligaments, and tendons)"

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© 2021 Birth Injury Justice Center – The information provided by is not a substitute for legal or professional medical advice. If you request any information you may receive a phone call or email from a partner law firm. If you call our legal help phone number, you will be connected to a partner law firm to discuss your inquiry.

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