What is Erb’s Palsy?

Erb’s palsy is a condition that causes weakness or paralysis of the arm on one side due to injury to the brachial plexus usually during childbirth. The condition was first described by Dr. Wilhelm Erb.

What is the Brachial Plexus?

Nerves leaving the spinal cord in the neck organize themselves into a network called the brachial plexus which supplies the shoulders, arms, wrists, and hands enabling sensation and movement.

How does Erb’s Palsy Occur?

The brachial plexus may be affected during delivery if the infant’s neck is stretched to one side. This can be due to abnormal birth positioning, large size of the infant, or prolonged labor. Erb’s palsy occurs when only the upper nerves of the plexus associated with shoulder and arm function are affected while hand and wrist function remain intact. A more severe form of brachial plexus palsy can affect the functioning of the entire limb.

What are the Symptoms of Erb’s Palsy?

Erb’s palsy affects the arm on one side and may result in weakness, poor grip strength, partial or complete paralysis, or loss of sensation. The arm may be bent at the elbow and held firmly against the side.

Diagnosis of Erb’s Palsy

Your doctor or pediatrician will make a diagnosis by performing a physical examination. Imaging studies of the neck and shoulder such as an X-ray, ultrasound, or MRI scan may be ordered. Neurological tests including an electromyogram or nerve conduction study may be performed to assess nerve function in the arm.

Erb's Palsy Treatment

In most cases of Erb’s palsy, recovery takes place on its own in about 3 months to 2 years. Your doctor will look for signs of recovery for a duration of at least six months and any progress will be monitored regularly. Physical therapy is recommended to promote movement and function of the limb and to avoid stiffness or contracture of the joints. The parents will be taught special exercises for their baby to perform on a regular basis.

Treatment and recovery depend on the degree of nerve injury. Injuries that cause stretching of the nerve (neuropraxia) without damage to the nerve fibers usually heal on their own. For more severe nerve injuries, your doctor may recommend microsurgery to repair or restore nerve tissue. Surgery can help injuries resulting in nerve fiber damage and scar tissue formation (neuroma). If a nerve is completely ruptured, healing will not take place without intervention. The condition can be treated using a nerve graft from your child’s body or a donor to restore movement. Full recovery is unlikely following surgery but with adequate rehabilitation, the outcome can be improved.

Additional surgery may be necessary to treat certain conditions such as joint contracture or stiffness that may develop. This can involve soft tissue release around the shoulder and elbow joints and a tendon transfer surgery to help your child raise the arm.