Erb’s palsy is a medical problem that can cause weakness or paralysis of an arm. The condition is most often seen in newborns and can occur during difficult deliveries when the baby’s neck is stretched to one side.
One or two of approximately every 1,000 babies are born with the condition, the American Academy of Orthopaedic Surgeons notes. Most babies born with Erb’s palsy, which is one type of brachial plexus palsy, recover feeling and movement in the impacted arm.
Some children suffer permanent effects, however. In some cases, the affected arm may be noticeably smaller than the arm that is not affected by the condition. The affected arm will grow as the child grows, but it may grow at a slower pace. In addition, Erb’s palsy may have an impact on a child’s self-esteem and quality of life, including the ability to participate in sports and to engage in some necessary activities of daily living.
What Causes Erb’s Palsy?
Children born with Erb’s palsy have suffered an injury to one or more of the nerves controlling the shoulder and the upper brachial plexus, or upper extremities. When the condition is seen in adults, which is much less often than in newborns, a patient typically has suffered an injury that caused trauma. The trauma can include tearing or stretching of the brachial plexus group of nerves that send signals between the spine and the hand, shoulder and arm.
When an infant’s upper nerves are affected by Erb’s palsy, the baby may not have the ability to move her shoulder, but she may be able to move her fingers. Prolonged labor, a large baby or a breech position in the womb are circumstances that can cause a case of Erb’s palsy in an infant.
In such difficult births, medical professionals may need to conduct a delivery quickly, which sometimes requires using force to pull the baby out of the birth canal. If a baby’s neck is stretched, the nerves also may become stretched and result in the injury.
Types of Erb’s Palsy Injuries
Erb’s palsy can include four types of injury to the brachial plexus nerves. An infant can suffer one or more — or even all four — at the same time.
A stretch injury that does not completely tear the nerve. Neurapraxia injuries typically heal on their own within approximately three months.
An injury that stretches the nerve, damaging some nerve fibers. Scar tissue that develops as a result may put pressure on the healthy portion of the nerve. Some recovery usually occurs, but recovery may not be total.
An injury that stretches the nerve and causes it to be torn. Ruptures typically do not heal without medical assistance.
A nerve is completely torn from the spinal cord. Avulsions and ruptures are the most serious types of injuries to a nerve. Ruptures sometimes can be repaired by splicing in a nerve graft from another donor child, but avulsions cannot be completely repaired. Some arm function may be restored with a nerve from a separate muscle.
Signs and Symptoms of Erb's Palsy
Regardless of the type of nerve injuries present in a case of Erb’s palsy, the symptoms are the same, including some combination of weakness, loss of feeling and partial or total paralysis in one arm. The severity of the nerve injury affects decisions on treatment and the level of recovery that can be expected.
A pediatrician typically diagnoses Erb’s palsy based on a physical examination, including observation of weakness in an arm. The doctor may order tests including an ultrasound, X-rays and other imaging to determine whether the bones and joints in the shoulder and neck have suffered damage. Tests to measure the presence of nerve signals in the upper arm muscle also may be conducted.
Treating Erb’s Palsy
Many babies born with Erb’s palsy recover from the condition on their own; your baby’s pediatrician will examine your child periodically to determine if there is recovery in the nerves. A complete recovery can take as long as two years. In addition, treatment can include both surgical and nonsurgical methods.
The primary nonsurgical treatment for Erb’s palsy is physical therapy conducted daily. Parents typically participate in helping to keep functioning muscles strong and joints moving smoothly. A doctor or physical therapist will show you how to do range-of-motion exercises with your baby after the age of approximately three weeks.
If your infant is not experiencing improvement after about three to six months, your pediatrician may recommend surgery on the affected nerves. Surgery usually does not restore full functioning of the affected arm, and it most often will not help older babies. Two types of surgery are possible:
- A nerve graft may repair a rupture injury by splicing in donor nerve material.
- A nerve transfer may restore some functioning by implanting a nerve from one of the child’s other muscles.
Will There Be Permanent Damage?
If your baby is suffering from Erb’s palsy, you’re likely wondering whether the damage will be permanent. The good news is that in most cases — between 80 and 96 percent — the condition completely resolves within the first year. When treatment begins within four weeks of birth, the recovery rate is nearly 100 percent.
It can take months or even years, though, for surgically repaired nerves to recover and reach the lower arm and hand muscles. Even after treatment, many children with Erb’s palsy may continue to experience some weakness in their hands, arms or shoulders. Children who don’t recover may experience ongoing damage to their self-esteem and emotional well-being along with their physical abilities.
Consult an Experienced Erb's Palsy Lawyer
If your baby suffered a traumatic birth that has caused Erb’s palsy, it’s critical to work with an experienced birth injury lawyer. Your child may need ongoing medical treatment and may suffer long-term effects that entitle you to compensation. To speak with an experienced attorney at no cost, please contact Ivan Diamond, Bronx Personal Injury Lawyer.