Erb’s Palsy
Reviewed by Edward Kulich, M.D.
Erb’s Palsy is a condition that can range from mild to severe, and is due to an injury suffered at birth during a vaginal delivery. In most cases, the injury heals on its own within a period of months; however, in some cases the condition can cause permanent damage. Erb’s Palsy is defined as a nerve injury that effects the movement of the shoulder, arm, and hand.
The brachial plexus nerve fibers can sometimes get stretched when the head and shoulders of a baby are pulled in opposite directions as he or she is delivered through the birth canal. This can cause a weakness in the upper arm and rotation of the lower arm, generally on one side of the body. Complications that arise from this condition can include partial, permanent, or total loss of function of the affected nerves, and can cause paralysis of the arm or arm weakness. If your newborn shows a lack of movement on either side, you should contact your health care provider immediately to seek treatment.
Erb’s Palsy Symptoms
Things you should watch for after a vaginal birth to determine whether or not your baby suffers from Erb’s Palsy are:
- Arm flexed at elbow and held against the body
- Decreased grip on the affected side
- Absent Moro reflex on the affected side
- Lack of spontaneous movement in the upper or lower arm or hand
Causes of Erb’s Palsy
As mentioned before, the main cause for Erb’s Palsy is the pulling and/or stretching of the head and shoulders in the opposite direction of one another during birth. During some deliveries, a baby’s head and neck are pulled toward the side as the shoulders pass through the birth canal to finish delivery, and this can cause Erb’s Palsy. Another common cause of Erb’s Palsy is when there is excessive pulling on the shoulders during a head first delivery or by applying pressure to the raised arms during a breech (feet first) delivery. Factors that can increase the chances of Erb’s Palsy include:
- Shoulder Dystocia (difficulty delivering baby’s shoulders through the pubic bone)
- Macrosomia (Big Baby)
- Breech Delivery
The good news is that medical technology and science have evolved, and the prevalence of Erb’s Palsy is decreasing year after year.
Erb’s Palsy Treatment
Thankfully, most patients go through a full recovery usually within 3-6 months after birth. If their strength has not returned at that point in time, surgery is usually performed to restore the nerves. Tendon transfers may also help the situation, as the tendons can act for the nerves that are not functioning properly. However, this is usually done in severe cases, or in cases that are showing no signs of improvement. In mild cases, gentle massage of the arms, shoulders, and hands is effective, as well as mild motion exercises of the inactive limb. The most common treatment is actually just watchful waiting and physical therapy. If that does not work, the three most common treatment methods for Erb’s Palsy are:
- Nerve transfers, usually from the opposite leg
- Sub Scapularis releases
- Latissimus Dorsi Tendon transfers
A Case Study
In Ohio, there is a little girl named Amari who suffered from Erb’s Palsy. Her parents and family began to notice a lack of movement in her left arm, and when there was no improvement after one month, Amari’s mom took her to the Brachial Plexus Center at Cincinnati Children’s Hospital Medical Center. The doctors there performed surgery to repair the damaged nerves. After surgery, Amari regained the use of both hands during activities such as swimming, catching a ball, and crawling. Although the surgery was deemed successful, Amari’s mom was not completely satisfied with the healing process. Amari’s elbow was still positioned incorrectly causing a limited range of motion. To treat the issues surrounding her injury, Amari began to receive Botox injections in her shoulder to relax her stronger arm muscles, which allowed her weaker ones to build strength. The procedure has helped improve her range of motion and muscle balance, so she will continue to receive the injections in the future. In addition to the injections, Amari, like so many other patients, continues to go to physical therapy sessions at the hospital and has a home exercise program.
