What is Erb's Palsy?

Erb’s palsy is a condition characterized by arm weakness and loss of motion. It can occur in both infants and adults. It’s typically caused by a physical injury during newborn delivery or by traumatic force downward on the upper arm and shoulder, damaging the brachial plexus. The brachial plexus is a network of nerves near the neck that provide movement and feeling to the shoulder, arm, hand and fingers. 

Baptist Health is known for advanced, superior care in diagnosing and treating Erb’s palsy. Our 24/7 inpatient neurology and neurosurgery services, as well as our outpatient services, Home Health, physical and occupational therapy services are available to help treat people with Erb’s palsy.

You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Erb's palsy symptoms will vary depending on the type of injury to the brachial plexus nerve. Erb’s palsy symptoms in babies and adults include:

• Loss of feeling in one arm
• Partial or total paralysis of one arm
• Weakness in one arm
• Numbness in one arm
• Limited motion of the arm

Diagnosis

To determine if an infant or older patient has Erb’s palsy, a physician will perform a physical examination to evaluate arm weakness. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures may include:

• Electromyogram (EMG): This test measures the electrical activity of a muscle in response to stimulation, as well as the nature and speed of the conduction of electrical impulses along a nerve. It can confirm the presence of nerve damage and assess its severity.
• Imaging studies: The physician may order an X-ray, ultrasound or other imaging test to check for damage to bones and joints of the neck and shoulder.
• Nerve conduction studies: These tests measure how well individual nerves can send an electrical signal from the spinal cord to the muscles.

A physician places a shock-emitting electrode directly over the nerve to be studied, and a recording electrode over the muscles supplied by that nerve. The shock-emitting electrode sends repeated, brief electrical pulses to the nerve, and the recording electrode records the time it takes for the muscle to contract in response to the electrical pulse.

Causes

Erb’s palsy typically occurs when an infant’s neck is stretched to the side combined with a downward force on the shoulder during a difficult delivery. Occasionally, Erb’s palsy occurs when a baby is larger than usual – making delivery difficult. This can occur due to poorly managed maternal diabetes or gestational diabetes.

Erb’s palsy can also be caused in older patients when a fall or accident causes traumatic downward force to the shoulder.

Risk Factors

Risk factors that may contribute to Erb’s palsy in infants include:

• Breech birth: Babies born feet-first are at a slightly higher risk of Erb’s palsy because their arms may be raised and more easily injured from excess pressure.
• Gestational diabetes: If blood sugar is not well-managed, babies may be born larger, making delivery more difficult.
• Improper delivery/ use of birthing tools: During a complicated delivery, a baby may be pulled quickly and forcibly from the birth canal, causing injury to the neck and shoulder.
• Large infant/small maternal size: Delivery may be more difficult if the infant is larger than normal or the mother is particularly petite.
• Second stage of labor lasting over an hour: A long-lasting “pushing” stage may put an infant at a greater risk of Erb’s palsy and other brachial plexus injuries.

Prevention

Most cases of Erb’s palsy in infants can be prevented by:

• Advanced planning: If the baby is larger than usual or in the incorrect position in the weeks leading up to the due date, advanced planning by the obstetrician to prevent Erb’s palsy should include ensuring qualified personnel are present in the delivery room, proper use of birthing instruments and extractors, and induction of labor or Cesarean delivery if several risk factors are identified.
• Maternal healthcare: Good maternal healthcare during pregnancy, including avoidance or control of diabetes, can help prevent Erb’s palsy.

Prognosis

Mild to moderate cases of Erb’s palsy resolve within a few months. For 70 to 80 percent of affected infants, and in nearly 100 percent of patients if treatment begins within four weeks of birth, it will resolve in the first year of life.

Treatment and Recovery

Treatment of Erb’s palsy may include:

Non-Surgical Treatments

Daily physical therapy is the most effective treatment for Erb’s palsy. Your physician or physical therapist will show you which therapeutic and range-of-motion exercises you must perform to promote healing and prevent joint stiffening in the shoulder, elbow, wrist and hand.

Surgical Procedures

If physical therapy doesn’t show promising results after three to six months, your physician may recommend surgery to repair damaged nerves. This may include:

• Nerve graft: Some nerve ruptures can be repaired by splicing a “donor” nerve graft from a separate nerve.
• Nerve transfer: In some cases, a surgeon can transfer a nerve from a different muscle to restore function in the nerve.
• Recovery: Because nerves recover very slowly, it may take months to years for nerves repaired at the neck to reach the muscles of the lower arm and hand. After surgery, you will need to perform rehabilitation exercises at home to improve your baby’s strength and range of motion.

Complications

Most infants and older patients with Erb’s palsy will recover strength and movement in the affected arm. Rarely, potential Erb's palsy complications that occur include:

• The affected arm may grow to be slightly shorter
• The affected arm failing to regain full strength or be unable to carry out circular movements