What You Need to Know

Erb’s palsy is a form of brachial plexus palsy. The brachial plexus is a network of nerves near the neck that runs down the spine to the shoulder and all the nerves of the arm. These nerves provide movement and feeling to the arms, hands and fingers. Palsy means “weakness,” and brachial plexus birth palsy causes arm weakness and loss of motion.

• Symptoms

  Erb’s palsy is usually diagnosed by a child’s pediatrician. The symptoms become more pronounced during developmental stages when a child first begins physical movement. The following symptoms may be evident during this period:

  • Lack of muscle control and feeling in the arms or hands
  • Lack of control while moving
  • Inability to use the shoulder or elbow
  • Paralysis of the arm
  • Needs help to sit up
  • Unable to crawl
• Causes

  It is estimated that one or two out of every 1,000 babies have Erb’s palsy.

  • It is often caused when an infant’s head and neck are pulled toward the side at the same time as the shoulders as they pass through the birth canal (also known as shoulder dystocia).
  • Erb’s palsy injury also occurs during birth when the newborn’s shoulder gets stuck behind the mother’s pubic bone during delivery.
  • The condition can also be caused by excessive pulling on the shoulders during delivery or by pressure on the raised arms during a breech birth.
• Types

  There are four types of Erb’s palsy:

  • Neuropraxia – This is the least severe and most common of all the brachial plexus injuries occurring outside the spinal cord. This is a “stretch injury” where the nerve is not torn but damaged by stretching. This causes a conduction block but fortunately does not involve permanent structural damage to the nerve.
  • Neuroma – When an injured brachial plexus nerve tries to repair itself, it forms scar tissue around the injury and interferes with the nerve sending signals to the muscles. The scar tissue forms specifically between the proximal and distal ends of the nerve to create a neuroma.
  • Rupture – In this injury, the nerve tears outside the spinal cord, causing damage to the nerve cells and supporting blood and connective tissue. If only the nerve cells are damaged, then they can fully recover and grow again.
  • Avulsion – This is the most severe type of Erb’s palsy, which involves the nerve being completely removed and torn off from the spinal cord. It usually occurs at the nerve rootlets or close to the spinal cord.
• Treatment

  Treatment for Erb’s palsy includes exercise, physical therapy and even surgical intervention. Surgery can be complicated and expensive but it is an effective solution for some infants.