Erb’s Palsy

Erb’s Palsy was first recognized as a birth injury in 1768. This condition is caused by a nerve injury in the baby’s upper arm suffered at birth during a vaginal delivery. This injury affects the movement of the shoulder, arm, and hand. In most cases, the injury heals on its own within a few months. In some cases, however, the condition can cause permanent damage.

The brachial plexus nerve fibers originate in the neck and travel to the arms. These fibers can sometimes get stretched when the head and shoulders of a baby are pulled as he or she is delivered through the birth canal. This stretch injury can lead to weakness in the upper and/or lower arm and rotation of the lower arm, generally on one side of the body. Erb’s Palsy is also referred to as BPI (brachial plexus injury).

Complications that can arise from this condition include partial, permanent, or total loss of function of the affected nerves, and weakness or even paralysis of the arm. If your newborn shows a lack of movement of either arm, 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 (bent) at elbow and held against the body
  • Decreased grip strength on the affected side
  • Absent Moro reflex (spreading arms wide apart when a baby feels like it is falling) on the affected side
  • Lack of spontaneous movement in the upper or lower arm or hand.
  • The affected arm appears floppy when the baby is turned from side to side.

Causes of Erb’s Palsy

The most common cause of Erb’s Palsy is the pulling or stretching of the head and shoulders in opposite directions during vaginal birth. During some deliveries, a baby’s head and neck are pulled toward the side as the shoulders pass through the birth canal, and this can cause Erb’s Palsy.

Another common cause of Erb’s Palsy is excessive pulling on the shoulders during a head-first delivery such as might occur when the head is “stuck” and the caregiver tries to pull harder and harder to get the baby out.

This condition can also occur due to the position of the baby in the birth canal. Sometimes, particularly with a larger baby who has broad shoulders, the head drops into the birth canal but one shoulder may be held back by the pubic bone. As the baby’s head is pushed lower in the birth canal, the nerves in the upper arm stretch, which can lead to a BPI. In cases like these, even a C-section birth may not be able to prevent this injury.

Factors that can increase the chances of Erb’s Palsy include:

  • Shoulder Dystocia (difficulty delivering baby’s shoulders past the pubic bone after the head has delivered)
  • Mother is diabetic
  • Macrosomia (big baby), with wide shoulders
  • Maternal pelvis is misshapen, either flatter or narrower than normal

Erb’s Palsy Treatment

Thankfully, most babies recover fully within three to six months after birth. If a patient has not recovered by that time, surgery is usually performed to repair the nerves. A procedure known as tendon relocation may also help the situation: This procedure essentially involves removing one end of a working tendon from its point of attachment and stitching it to a paralyzed muscle, enabling the patient to move that muscle. However, this is usually only done in severe cases, or in cases that show no signs of improvement after other treatments have been tried.

In mild cases, gentle massage of the arms, shoulders, and hands is effective. Gentle motion exercises involving the inactive limb can also be helpful. The most common treatment is actually just watchful waiting and physical therapy.

The good news is that the prevalence of Erb’s Palsy is decreasing every year. Currently it is recognized in about 1–2 births per 1,000. The rate of recovery is as high as 80 to 96 percent, especially if some improvement is seen within the first two weeks.

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, enabling her to swim, catch a ball, and crawl. Although the surgery was deemed successful, Amari’s mom was not completely satisfied with the healing process. Amari’s elbow was still positioned incorrectly, which limited her range of motion. To further treat 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 many other patients, has a home exercise program and continues to go to physical therapy sessions at the hospital.

This page was last updated on 06/2017

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