Written by Trevor Ward, Birth Injury Unit Specialist

What is Erb’s Palsy?

Erb’s Palsy is a condition which research suggests affects 1-2 in every 1000 births. The condition is a type of injury caused to the brachial plexus nerve network which links the spinal cord and the arm.

The condition usually effects the upper part of the arm from the elbow to the shoulder. As a result of this, hands tend not to be affected, however we have known clients to experience tingling and numbness from time to time.

Are there different types of Erb’s Palsy?

Yes, there are 4 different types of Erb’s Palsy which relate to the different injuries that can affect the brachial plexus:

1. Avulsion – this occurs when the nerves that make up the brachial plexus tear away from the spine, this is considered the most serious type of Erb’s Palsy.
2. Rupture – this type is again when the nerves are torn but they have not come away from the spine.
3. Neuroma – this type of Erb’s Palsy is where the nerve has torn but has healed and scar tissue is left behind. The scar tissue then applies pressure to the injured nerve and prevent it from conducting signals to the muscles from the spinal cord.
4. Neurapraxia – this is where the nerve has become stretched but has not torn. This is thought to be the most common type of brachial plexus injury.

Is there a difference between Erb’s Palsy other types of palsy?

You may have heard of other types of palsy such as Cerebral Palsy and Klumpke’s Palsy. There are differences between all three types; some more subtle than others.

The main difference between Erb’s Palsy and Cerebral Palsy is that Erb’s Palsy is caused by damage to the nerves in the neck, and Cerebral Palsy is caused by damage to the brain.

Klumpke’s Palsy is similar to Erb’s Palsy in the sense that damage to the brachial nerves is the cause of the condition. However, Klumpke’s Palsy affects the lower part of the arm and hands, and Erb’s Palsy affects the upper arm.

What causes Erb’s Palsy?

With regard to infants, the most common cause of Erb’s Palsy is a difficult childbirth, according to Cerebral Palsy Guidance. With the damage to nerves more likely if the child is abnormally large, born breech or labour goes on for an extended period of time.

The injury can be caused by:

• Pulling on the shoulders of the child if they were to be delivered in a headfirst position.
• Pressure on the child’s arms if they are in the breech position.
• Pulling on the child’s head as it comes out of the birth canal.

At times, injuries can happen unexpectedly and may be unavoidable. This could occur if a medical professional was to pull the baby too hard in one direction during delivery, this could happen during a complicated or lengthy delivery.

In adults, Erb’s Palsy may be caused by:

• A traffic accident
• Gunshot or knife wound
• Industrial accidents
• Accidents relating to sports contact
• Surgical complications or tumours

Are there any risk factors that would make someone more susceptible to Erbs Palsy?

There are several known risk factors of Erb’s Palsy to be aware of, according to Birth Injury Help Center:

• The second stage of labour lasting longer than an hour
• A pregnancy which goes beyond 40 weeks
• Maternal weight gain which is considered excessive
• A contracted or flat pelvis
• Gestational diabetes
• A previous delivery with a brachial plexus injury

Erb’s Palsy Symptoms

Cerebral Palsy Guide say that symptoms of Erb’s Palsy generally only affect one side of a new-born’s body. The severity of the Erb’s Palsy symptoms will depend upon how seriously the brachial plexus has been injured.

If the brachial plexus nerves are severely injured and torn from the spinal cord, it is likely that the child may suffer from paralysis in the arm, whereas if the nerve is only stretched, they may just feel some numbness.

The most common Erb’s Palsy symptoms include:

• A limp arm
• Suffering muscle weakness
• Numbness in the arm
• Reduced ability to grip
• Partial or complete paralysis of the arm
• Waiter’s tip (dangling of the arm with fingers curved upwards)

What can be done to treat Erb’s Palsy?

In some circumstances, mild cases of numbness or paralysis caused by the condition in new-born babies may heal itself within a few months. However, in more serious cases there may be a requirement for surgery or physical therapy.

It may also be necessary that your child receives more extensive treatment if the condition continues to disrupt their movements and development after 6 months.

Below are some of the common treatments for Erb’s Palsy:

Physical Therapy – This is carried out to improve any stiffness and lack of mobility in the child’s shoulders and arms. Within this therapy, message techniques, motion exercises and exercise equipment may be used. Infants may be able to start this therapy from as young as 3 weeks old.

Occupational Therapy – This type of therapy is often used for children when the condition has not improved itself after 2-4 months. The therapy can help a child improve their strength and perform everyday activities such as picking up objects. Within the therapy, a range of exercises are likely to be used to improve joint stability and muscle tone.

Surgery – Surgery will take place when a child has a severe case of Erb’s Palsy to repair the nerve damage they have suffered; and also to fix the paralysis in the arm. Surgery should be conducted without delay, as this would greatly impact the chances of a successful recovery. This treatment usually involves a healthy nerve being extracted from another part of the body and attached to the damaged nerve. The movement of a healthy tendon to the affected area may also be required to help improve the arm mobility.

Have you suffered negligence relating to Erb’s Palsy?

As medical negligence experts, we have many years of experience handling complex Erb’s Palsy and birth injury cases. If you believe you or your child has been affected by negligence relating Erb’s Palsy, our specialists are here to help.