Birth Injury Resource Center

Erb’s Palsy

Erb's palsy is a type of injury in which a network of nerves in the neck, known as the brachial plexus, is stretched. The result is a loss of movement and feeling in the arm, hand and fingers. Although a brachial plexus injury can occur at any time, most cases of Erb's palsy are the result of injuries that happen during the birthing process.

One to two of every 1,000 babies are afflicted by Erb's palsy. Fortunately, it is almost always a temporary condition. In time, and with proper treatment and therapy, most infants who suffer a brachial plexus injury will recover full use of their affected arms.

Erb’s Palsy Risks and Symptoms

Most brachial plexus injuries happen to newborns during a difficult delivery. Conditions known to increase the risk for Erb's palsy include:

• a large baby
• breech presentation
• prolonged labor
• shoulder dystocia
• use of force to pull the baby from the birth canal

The symptoms of Erb's Palsy are usually evident immediately or shortly after birth. At this time, a doctor or parent may observe one or more of the following signs in an infant who has suffered a brachial plexus injury:

• lack of movement in the arm or hand
• weak grip
• missing Moro reflex, a normal reflex that causes an infant to react when startled by a sudden, loud noise by stretching out the arms and flexing the legs
• inability to maintain the arm in a normal position (flexed at the elbow and held against the body)

Treatment and Prognosis for Erb’s Palsy

The prognosis for Erb's palsy depends largely on the type of injury sustained. There are four types of brachial plexus injuries, and an infant may experience one or more of them.

• Avulsion is the least common and most severe type of brachial plexus injury, in which the nerve is torn from the spine.
• Rupture occurs when the nerve is torn, but not separated from the spine.
• Neuroma is scar tissue that grows around the injury, putting pressure on the injured nerve and interfering with the nerve's ability to conduct signals to the muscles.
• Neurapraxia, the most common type of brachial plexus injury, occurs when the nerve has been damaged but not torn.

Neurapraxia injuries typically heal within three months of birth without assistance. In more serious cases of Erb's palsy, weakness and loss of feeling may persist. If no significant improvement in arm strength is seen within three to six months of age, corrective surgery may be required.

In the case of nerve ruptures and avulsions--the most serious types of nerve injury seen with Erb's palsy--it may be possible to repair a rupture by grafting a nerve from another nerve in the child's body. Although it is not possible to repair a tear from the spinal cord, nerve grafts may help to restore some function in the arm.

Erb’s Palsy Support for Parents

If your child suffers from Erb's palsy or another childbirth-related injury, it may help to speak to other parents in a similar situation. Please visit the Birth Injury Resource Center Discussion Board to share your story, ask questions, and learn more about the topic of birth injuries.

Resources

• American Academy of Orthopaedic Surgeons: Erb's Palsy
• National Institute of Neurological Disorders and Stroke: Brachial Plexus Injurires
• MedlinePlus: Brachial palsy in newborns