Erb’s palsy, also known as brachial plexus birth palsy, is a condition characterized by arm weakness or paralysis due to injury to the brachial plexus nerves during childbirth. The brachial plexus is a network of nerves that control movement and sensation in the shoulder, arm, and hand.

Common Symptoms

Common symptoms of Erb’s palsy include:

• Limp or paralyzed arm
• Lack of muscle control in the arm
• Numbness or loss of feeling in the arm
• Limited or no movement of the shoulder, arm, or hand
• Arm hanging by the side with forearm pronated and wrist bent back (“waiter’s tip” position)

Cause & Anatomy

The most common cause of Erb’s palsy is a difficult childbirth, where the baby’s shoulder becomes stuck behind the mother’s pubic bone (shoulder dystocia). This can stretch or tear the brachial plexus nerves, resulting in nerve damage. The brachial plexus is a bundle of nerves that originate from the spinal cord in the neck and control muscle function and sensation in the shoulders, arms, and hands.

Diagnosis

Erb’s palsy is typically diagnosed through a physical examination by a doctor, who will check for signs of arm weakness, lack of movement, and muscle atrophy. Additional tests may include:

• Electromyography (EMG) to assess nerve function
• Imaging tests like X-rays, CT scans, or MRI to check for nerve damage

Prevention

• While Erb’s palsy is often unavoidable, some steps that may reduce the risk include:
• Proper management of difficult deliveries by trained medical professionals
• Avoiding excessive traction or force on the baby’s head and neck during delivery

Treatment

Treatment for Erb’s palsy depends on the severity of the injury:

• Mild cases may resolve with physical therapy and range-of-motion exercises alone.
• More severe cases may require surgery to repair or graft damaged nerves.

Surgery

Surgical options for Erb’s palsy include:

• Nerve grafting: Using a healthy nerve from another part of the body to repair a torn nerve
• Nerve transfer: Rerouting a nearby healthy nerve to restore function
• Muscle transfer: Transferring a muscle and its nerve supply to restore function

Rehabilitation

Regardless of treatment, physical and occupational therapy are crucial for rehabilitation. Therapy focuses on:

• Range-of-motion exercises
• Strengthening exercises
• Sensory activities to restore feeling
• Improving daily living skills like dressing, eating, writing

FAQ’s

Is Erb’s palsy permanent?
In most cases, Erb’s palsy is not permanent. With proper treatment, around 80-90% of infants recover full function within 1-2 years.

Can Erb’s palsy be prevented?
While often unavoidable, the risk may be reduced by proper management of difficult deliveries by experienced medical professionals.

When should treatment start?
Early treatment, ideally within the first 4 weeks after birth, provides the best chance for full recovery.