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Erb's palsy

Erb’s palsy is a form of nerve damage that can cause muscle weakness or paralysis in a baby’s arm. While some cases resolve with time, others may result in lasting harm. In some cases, the birth injury is caused by medical mistakes during delivery. Learn what causes Erb’s palsy and what options you may have if your baby was harmed.

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About 2 in every 1,000 babies are born with Erb's palsy. Was your child one of them?

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What is Erb’s palsy?

Illustration showing where the shoulder is affected in a baby with Erb's palsy.

Erb’s palsy is a type of brachial plexus injury that affects movement and strength in a baby’s upper arm. The brachial plexus is a network of nerves near the neck that controls the shoulder, arm, and hand.

These nerves can be stretched or torn during a difficult or forceful delivery, leading to weakness or paralysis in the affected arm. In most cases, only one side is involved.

Erb’s palsy is also known as Erb-Duchenne palsy or brachial plexus palsy. It affects up to 2 in 1,000 newborns, according to the American Academy of Orthopedic Surgeons (AAOS).

Many babies with Erb’s palsy improve with early treatment. Physical and occupational therapies can help restore movement, but recovery often demands major changes at home. Parents may need to miss work, adjust routines, or travel to specialists.

Unfortunately, some children never fully recover. Lasting weakness, limited arm function, or visible differences can affect a child’s daily life. In severe cases, surgery may be needed, and even then, full function may not return.

Sometimes, Erb's palsy in newborn babies could have been avoided during delivery. When health care providers use excessive force or miss warning signs, medical negligence may be involved. In these cases, an Erb’s palsy lawsuit can help families afford long-term care.

We partner with birth injury lawyers nationwide who have secured over $1 billion for families, including those impacted by Erb’s palsy.

Find out if we can help your family, too. Get a free case review right now.

Causes of Erb’s palsy

The cause of Erb’s palsy usually involves excessive stretching of the brachial plexus nerves during delivery. While some Erb's palsy risk factors are unavoidable, others involve poor medical decisions or mistakes that lead to preventable nerve injury.

Learn more about common Erb's palsy causes below.

Improper management of shoulder dystocia

Shoulder dystocia occurs when a baby’s shoulder gets stuck behind the mother’s pelvic bone after the head has delivered. When this happens, doctors must act quickly and carefully to avoid injury.

Common errors in managing shoulder dystocia include:

  • Failing to perform appropriate maneuvers to release the shoulder
  • Neglecting to call for additional help or following emergency protocols
  • Not recognizing shoulder dystocia in time to reduce the risk of injury
  • Pulling too hard on the baby’s head or neck during delivery

When this medical emergency is not handled correctly, shoulder dystocia is a leading cause of Erb’s palsy.

Misuse of assisted delivery tools

Forceps and vacuum extractors are sometimes used to guide a baby through the birth canal. These tools must be applied with skill and care.

Misuse of assisted delivery tools may involve:

  • Applying pressure to the baby’s head in the wrong direction
  • Attempting multiple applications after an initial failure
  • Choosing to proceed with tools when a C-section would have been safer
  • Placing the device incorrectly on the baby’s scalp or head
  • Pulling too forcefully or quickly during delivery

Improper use of assisted delivery tools increases the risk of brachial plexus injuries like Erbs palsy.

Excessive pulling during vaginal delivery

Even without shoulder dystocia or tools, a medical provider can cause nerve damage by using too much force during delivery.

Situations that may involve excessive pulling include:

  • Attempting to deliver a large baby through a narrow birth canal
  • Handling breech deliveries (feet- or buttocks-first) improperly
  • Pulling a baby’s head or neck in a way that overstretches the nerves

These actions can result in partial or complete tearing of the brachial plexus in fragile newborns. When excessive force is used unnecessarily, it may be considered medical negligence.

Failure to perform a timely cesarean section

In some cases, a cesarean section (C-section) is the safest way to prevent injury. Delaying surgery when it is medically necessary can lead to complications during vaginal birth.

Common reasons a C-section should be considered include:

  • Baby appears too large for safe vaginal delivery (macrosomia)
  • Labor is prolonged or not progressing as expected
  • Signs of fetal distress or positioning issues are present

Failing to act may increase the risk of nerve damage, like Erbs palsy and other brachial plexus injuries.

Inadequate monitoring of labor progress

Monitoring a mother and baby throughout labor is essential for identifying risks before they lead to harm. When providers fail to recognize or act on warning signs, it can result in serious injury.

Failures that may contribute to Erbs palsy include:

  • Failing to adjust the delivery plan when complications arise
  • Ignoring signs that labor has stalled or is moving too quickly
  • Missing evidence of a high birth weight or abnormal fetal positioning
  • Overlooking fetal distress or warning signs during electronic monitoring

Without timely action, these lapses can increase the risk of nerve damage. If you think your baby’s Erbs palsy could have been prevented, you may qualify for compensation to help cover the cost of care.

Find out right now with a free case review.

Signs and symptoms of Erb’s palsy

A baby sleeping peacefully in the arms of a caregiver.

The symptoms of Erb’s palsy in children can vary depending on the severity of the nerve damage. Some children have mild weakness, while others experience total paralysis in the affected arm.

Signs are often noticeable at birth, but the full extent of harm may not become clear until the baby is 3 to 6 months old.

Common symptoms of Erb’s palsy include:

  • Arm hangs by the side with wrist turned inward (“waiter’s tip”)
  • Decreased grip strength
  • Limited range of motion in the arm or shoulder
  • Partial or complete paralysis of the arm
  • Weakness in the arm or hand

If your baby shows any of these signs, talk to your doctor as soon as possible. Early diagnosis gives your child the best chance at recovery.

Types of Erb’s palsy

Doctors classify brachial plexus injuries based on how severely the nerves are damaged. These types help determine the treatment and expected recovery for babies with Erb’s palsy.

Learn more about the types of nerve injuries that can cause Erbs palsy below.

Neuropraxia

Neuropraxia is the mildest and most common type of brachial plexus injury. It occurs when the nerve is stretched but not torn. Babies with neuropraxia usually recover fully within weeks to a few months, often without the need for surgery.

Neuroma

A neuroma occurs when a stretched or torn nerve begins to heal, but scar tissue forms at the injury site. This scar tissue can press on healthy nerves and limit recovery. Children with neuromas may regain some function, but often not fully.

Rupture

A rupture is a complete tear of the nerve, but not at the spinal cord. Because these nerves cannot heal on their own, surgical intervention — such as nerve grafting — is usually required to restore function.

Avulsions

Avulsions are the most severe type of nerve injury. They occur when the nerve is torn away from the spinal cord. This can cause permanent paralysis in the arm and may also lead to Horner’s syndrome, affecting the face and eyes.

Erb’s palsy surgery may help improve function by transferring nearby nerves, but the torn nerve cannot be reattached.

If you're unsure what type of nerve injury your baby may have, our registered nurses can help you understand your baby’s condition and what steps to take next.

With decades of combined experience supporting families like yours, our nurses are here to help, and talking with our team is always free.

Erb’s palsy treatment

Some mild cases of Erb’s palsy in newborns improve on their own within a few months. More serious injuries may require ongoing Erb’s palsy treatment, including physical therapy or surgery.

If your child still has limited movement or delayed development after 6 months, more intensive care may be needed to support long-term recovery.

Learn more about Erb’s palsy treatments below.

Physical therapy

Physical therapy is often the first step in treating brachial plexus injuries like Erbs palsy. It helps improve stiffness, immobility, and weakness in the affected shoulder or arm.

Therapists may use gentle massage, range-of-motion exercises, and specialized equipment to support nerve recovery and build strength. Many babies can begin home therapy as early as 3 weeks old, under the guidance of a specialist.

Occupational therapy

Occupational therapy is typically recommended when symptoms don’t improve on their own after 2 to 4 months.

This therapy focuses on helping children build the strength and coordination needed for everyday activities, such as holding a toy or bottle. Occupational therapists use targeted exercises to improve joint function, muscle tone, and fine motor skills.

Surgery

Surgical treatment is sometimes needed for more severe cases of Erbs palsy, especially when there is significant nerve damage or paralysis.

The most common procedure is a nerve transfer, where a healthy nerve from another part of the body is connected to the damaged nerve. In some cases, doctors may also perform a tendon transfer, moving a tendon to improve mobility in the arm, shoulder, or hand.

Early surgical intervention is important, as delays can reduce the chances of full recovery. These procedures can be costly, but money from a lawsuit can help cover the expense.

Get a free case review right now to find out if your family may qualify.

Long-term effects of Erb’s palsy

For some children, Erb’s palsy improves with early therapy and consistent follow-up care. However, when treatment is delayed or the nerve damage is more severe, the effects can be permanent.

If your child’s injury was avoidable, an Erb’s palsy settlement may help your family afford the treatment and support needed for the best possible outcome.

Potential long-term effects of Erb’s palsy include:

  • Chronic pain: Ongoing discomfort or sensitivity in the affected arm
  • Delayed development: Slower progress with motor skills and milestones
  • Joint stiffness: Limited flexibility in the shoulder, elbow, or wrist
  • Limited range of motion: Difficulty lifting, rotating, or extending the arm
  • Muscle atrophy: Weakening or shrinking of muscles due to lack of use
  • Paralysis: Partial or complete loss of movement in the arm or hand
  • Poor coordination: Trouble with balance, reaching, or grasping objects
  • Self-esteem issues: Emotional effects related to physical limitations
  • Uneven arm growth: The affected arm may appear shorter or thinner over time

These outcomes can impact a child’s ability to participate fully in school, play, and daily routines. Early treatment is critical to improve function and reduce long-term harm.

Get legal help for Erb’s palsy

When Erb’s palsy is caused by mistakes during delivery, the effects can be life-altering, not just for your child, but for your entire family.

A preventable nerve injury may require years of therapy, surgery, and support. These costs can be overwhelming, especially when insurance doesn’t cover everything your child needs.

An Erb’s palsy settlement can provide the financial resources to afford high-quality care, adaptive equipment, and long-term stability.

Legal help can also bring answers — and a sense of justice — for families navigating the lifelong impact of avoidable nerve damage.

Cerebral Palsy Guide partners with top birth injury lawyers who can help families in all 50 states. So far, they’ve recovered over $1 billion for families affected by birth injuries, including Erb’s palsy.

Call our team at (855) 220-1101 right now or get a free case review to find out your legal options.

Erb's Palsy FAQs

What is Erbs palsy?

Erbs palsy is a type of brachial plexus injury that affects the nerves controlling a baby’s shoulder, arm, and hand. The brachial plexus is a group of nerves near the neck that control movement and feeling in the upper limbs.

This injury often happens during birth when the baby’s shoulder gets stuck behind the mother’s pelvic bone, a complication known as shoulder dystocia.

What does Erb's palsy look like?

Erb's palsy often causes a baby’s arm to hang limp at their side with limited or no movement. The palm may face backward, and the elbow may stay bent, a position sometimes called the “waiter’s tip.”

You may also notice weak muscle tone, a poor grip, or that one arm moves much less than the other.

What is the difference between Erb's palsy and Klumpke's palsy?

Erb's palsy affects the upper brachial plexus nerves, leading to weakness or paralysis in the shoulder and upper arm.

Klumpke's palsy involves the lower brachial plexus nerves, causing issues in the forearm, wrist, and hand. The key difference is which part of the arm is affected.

What causes Erb's palsy?

Erb's palsy is caused by damage to the brachial plexus nerves during childbirth. This often happens when a baby’s neck is stretched too far to one side, usually during a difficult or forceful delivery.

Certain labor complications and medical decisions may increase the risk. Common causes of Erb’s palsy include misuse of assisted delivery tools or mismanagement of shoulder dystocia.

If you believe your child’s Erbs palsy could have been prevented, you may be eligible for compensation. Get a free case review right now.

What are the common Erb's palsy risk factors?

Certain pregnancy and delivery conditions can increase the risk of Erb's palsy. These factors may raise the chance of brachial plexus injury during childbirth, especially if not managed carefully by medical staff.

Common risk factors for Erb’s palsy include:

  • Breech position at birth
  • Large baby (macrosomia)
  • Maternal diabetes
  • Prolonged second stage of labor
  • Shoulder dystocia

Doctors are trained to manage these and other delivery risks. When they don’t, it may be considered medical negligence. In these cases, working with an Erb’s palsy law firm may help your family pursue compensation for your child’s care.

Does Erb's palsy go away?

Some cases of Erb's palsy improve over time, especially when the nerve damage is mild. With early physical therapy, many babies regain strength and movement within a few months.

However, more severe injuries may cause lasting weakness, limited motion, or permanent paralysis, even with treatment. The outcome depends on the type and extent of the nerve damage.

How do you treat Erb’s palsy?

Treatment for Erb’s palsy depends on how severe the nerve injury is. Many babies start with physical therapy to improve strength and movement in the affected arm.

If there’s little progress after a few months, occupational therapy may be added to support daily function. In more serious cases, surgery such as nerve or tendon transfer may be needed to restore mobility.

What are the long-term effects of Erb's palsy?

Some children with Erb's palsy recover fully, but others may face lasting challenges. Severe or untreated nerve damage can lead to permanent weakness, limited range of motion, or paralysis in the affected arm.

Additional long-term effects may include joint stiffness, uneven arm growth, poor coordination, and self-esteem issues related to physical differences.

Can you sue for Erb’s palsy?

Yes, you may be able to sue if your child’s Erb’s palsy was caused by medical negligence during delivery.

An Erb’s palsy lawsuit allows families to seek compensation for medical care, therapy, and long-term support.

Call us at (855) 220-1101 right now or Click to Live Chat and see if you may qualify.

Reviewed by:Katie Lavender, RN

Registered Nurse

  • Fact-Checked
  • Editor

Katie Lavender has over 10 years of experience as a Registered Nurse in postpartum mother/baby care. With hands-on experience in Labor and Delivery and a role as a Community Educator for newborn care, Katie is a staunch advocate for patient rights and education. As a Medical Reviewer, she is committed to ensuring accurate and trustworthy patient information.

Cerebral Palsy Guide was founded upon the goal of educating families about cerebral palsy, raising awareness, and providing support for children, parents, and caregivers affected by the condition. Our easy-to-use website offers simple, straightforward information that provides families with medical and legal solutions. We are devoted to helping parents and children access the tools they need to live a life full of happiness

  1. American Academy of Orthopaedic Surgeons (AAOS). (2023). Erbs palsy (brachial plexus birth palsy). Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/erbs-palsy-brachial-plexus-birth-palsy.
  2. American College of Obstetricians and Gynecologists (ACOG). (2024). Shoulder dystocia. Retrieved from https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/05/shoulder-dystocia.
  3. Baptist Health. (n.d.). Erbs palsy. Retrieved from https://www.baptisthealth.com/services/neurology-care/conditions/erbs-palsy.
  4. Boston Children’s Hospital. (n.d.). Brachial plexus birth injury. Retrieved from https://www.childrenshospital.org/conditions/brachial-plexus-birth-injury.
  5. Genetic and Rare Diseases (GARD) Information Center. (2025). Klumpke's paralysis. Retrieved from https://rarediseases.info.nih.gov/diseases/3123/klumpke-paralysis.
  6. Johns Hopkins Medicine. (n.d.). Brachial plexus injury. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/brachial-plexus-injuries.
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