Defining Erb’s Palsy (Brachial Plexus Birth Palsy)

Published on May 6, 2015

What is Erb’s Palsy?

Erb’s Palsy is a form of brachial plexus birth palsy that affects one of every 1,000 babies. It’s named Erb’s Palsy after one of the doctors who first described this condition, Wilhelm Erb. Brachial plexus is a collection of nerves near the neck that give rise to all the nerves of the arm. These nerves provide movement and feeling to the shoulder, arm, hand, and fingers. Palsy means weakness. Therefore, brachial plexus birth palsy is a birth injury related to the loss of movement or weakness of the arm.

What causes Erb’s Palsy?

When the nerves of the brachial plexus are injured during a difficult delivery, it could be caused by:

-The infant’s head and neck pulling toward the side as the shoulders pass through the birth canal
-Pulling or exerting force on the infant’s shoulders during a head-first delivery
-Pressure on the baby’s raised arms during a breech (feet-first) delivery

What increases the risk of brachial plexus injury?

-Breech delivery
-Larger than average newborn
-Difficulty delivering the baby’s shoulder after the head has already come out (called shoulder dystocia)

What are the symptoms of Erb’s Palsy?

-No movement in the newborn’s upper or lower arm or hand
-Absent Moro reflex on the affected side
-Arm flexed (bent) at elbow and held against body
-Decreased grip on the affected side
-Loss of feeling in the arm
-Partial or total paralysis of the arm

Note: Brachial plexus injury is sometimes confused with pseudoparalysis. This is when the infant has a fracture and is not moving the arm because of pain, but there is no nerve damage.

How do you treat Erb’s Palsy?

For mild cases, a gentle massage of the arm and range-of-motion exercises are recommended. Daily physical therapy is the main treatment method and should be done as often as possible during the day. The exercises will prevent the joint from becoming permanently stiff, a condition called joint contracture. If the damage is severe enough or the condition doesn’t improve in the first few weeks, your baby may need to be evaluated by specialists. Surgery may also be considered if some strength has not returned to the affected muscles by the time the baby is 3 to 6 months old. Most babies will fully recover within 3 to 6 months. Those who don’t recover during this time have a poor outlook. In these cases there may be a separation of the nerve root from the spinal cord (avulsion).

What can you do to prevent Erb’s Palsy?

Prevention of Erb’s Palsy is largely in the hands of your doctor. This is why it’s so important to choose the best doctor for you. A simple search on Google could tell you if any lawsuits against your doctor exist. Once you have a doctor, talk about a birth plan and all possible scenarios early. This gives you plenty of time to research and arm yourself with the information you need to make an informed decision prior to giving birth. If there are concerns about a difficult delivery, a cesarean delivery is often used to reduce the risk of injury. However, keep in mind this cannot prevent Erb’s Palsy from happening, and there are other risks involved with C-sections.