Erb's Palsy

Erb’s palsy is a birth injury affecting the brachial plexus nerves in the neck, causing weakness or paralysis of the arm. According to the American Academy of Orthopedic Surgeons (AAOS), 1 out of 1,000 babies is born with Erb’s palsy. Most children will regain movement and feeling in the affected arm. Learn more about Erb’s palsy causes, treatment, and more.

erbs palsy baby illustration

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What Is Erb’s Palsy?

erbs palsy baby illustrationErb’s palsy, also called brachial plexus palsy or Erb-Duchenne palsy, is a type of birth injury that can develop when an infant’s neck is stretched to one side during a difficult delivery.

The brachial plexus is a network of nerves that runs down the spine. It gives feeling and control to muscles in the arms, shoulders, elbows, wrists, and hands.

When these nerves are damaged during childbirth, it may result in temporary or permanent paralysis of the arm.

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Erb’s Palsy vs. Other Birth Injuries

Brachial plexus birth palsy is very different from cerebral palsy, another type of birth injury. Erb’s palsy is caused by damage to neck nerves, whereas cerebral palsy is caused by damage to the brain.

Erb’s palsy also differs from other brachial plexus injuries such as Klumpke’s palsy. This condition is uncommon in babies and causes paralysis of the lower brachial plexus, affecting hand muscles. Brachial plexus palsy affects voluntary movement in the upper arm and range of motion in the lower arm.

If you believe your child may have suffered from Erb’s palsy, speak with one of our registered nurses. We can help you determine the cause of your child’s injury.

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Types of Erb’s Palsy

There are four main types of brachial plexus palsy. Doctors determine the type of brachial plexus palsy based on the degree of damage to the brachial plexus nerve.

Learn more about the different Erb’s palsy types below.

Neuropraxia

Neuropraxia is the most common type of Erb’s palsy and occurs when a nerve is stretched but does not tear at all. Neuropraxia can cause a burning or stinging sensation and usually clear up on its own by 3 months of age.

Neuroma

Neuromas are more severe than neuropaxias. When neuromas occur, scar tissue forms as it heals itself from the stretching and places pressure on the other healthy network of nerves. Generally, children with neuroma Erb’s palsy partially heal.

Rupture

Ruptures occur when the brachial plexus nerve is torn. Ruptures require more intensive medical care since they will not heal. This injury usually requires surgery to graft the damaged nerve fibers back together.

Avulsions

Avulsions are the most severe type of nerve injury and they occur when a nerve is completely torn from the spinal cord. This can cause permanent paralysis or muscle weakness in the affected arm. It can also lead to Horner’s syndrome and cause difficulty breathing, drooping eyelids, and small pupils.

Surgery may help to repair avulsions, but the affected nerve cannot be reattached to the spinal cord.

The best and only way to determine which type of brachial palsy your child may have is to consult with a doctor. Once diagnosed, you can determine the best treatment options for your child’s condition.

Causes of Erb’s Palsy

Erb’s palsy is often caused by excessive pulling or stretching of an infant’s head and shoulders during a difficult or prolonged delivery. Erb’s palsy can develop if an infant’s head and neck are pulled to the side at the same time as the shoulders pass through the birth canal.

During difficult childbirths, doctors may have to move quickly to deliver the baby and may exert extra force to get the child out of the birth canal. This can stretch the baby’s neck and may result in Erb’s palsy.

Brachial plexus palsy can also develop due to the baby being in an awkward position in the womb.

This can occur if an infant’s shoulder is stuck behind the mother’s pubic bone when their head drops into the birth canal. This can stretch the brachial plexus nerves as the baby’s head is pushed out.

The risk of a child developing Erb’s palsy nearly triples if they develop shoulder dystocia during birth. Shoulder dystocia occurs when an infant’s head is delivered but both of their shoulders get stuck inside the mother’s womb.

There are several other risk factors that can increase the chances of a child developing Erb’s palsy.

Risk factors of Erb’s palsy include:

  • C-section (cesarean section)
  • Excessive maternal weight gain
  • Forceful pulling on the arm
  • Large infant size or high birth weight
  • Maternal diabetes
  • Second stage of labor lasting over an hour
  • Small or abnormal maternal pelvis shape
  • Use of assistive delivery tools such as forceps or vacuum extractor
  • Other forms of medical negligence

Many causes of brachial plexus palsy stem from medical negligence. This can occur when a doctor, nurse, or another medical professional makes serious medical errors that cause injury to the baby.

If you believe your child developed Erb’s palsy due to medical negligence, you may be eligible to take legal action. Get a free case review today to see if you qualify for financial compensation.

Signs & Symptoms of Erb’s Palsy

erbs palsy babyThe symptoms of Erb’s palsy can vary depending on the type and severity of the condition. Erb’s palsy symptoms can range from weakness or soreness to total paralysis of the affected arm.

Symptoms are often recognizable at birth, but the severity of nerve damage and the limits on a child’s movement may not be determined until the child is 3 to 6 months old.

The most common symptoms of Erb’s palsy include:

  • Arm hangs by the side and wrist rotates inward (waiter’s tip)
  • Decreased grip strength
  • Limited motion of the arm
  • Numbness in arm
  • Partial or total paralysis of the arm
  • Weakness in the arm

It is important to contact your doctor if your child is showing any of the signs listed above. The sooner you get a diagnosis, the sooner your child can get treatment.

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Erb’s Palsy Treatment

Some mild cases of paralysis caused by Erb’s palsy in newborns can resolve on their own within a few months, but more severe cases require more in-depth treatment such as therapy or surgery.

Your child may require more intensive treatment if their range of movement and development is still delayed after six months.

Learn more about Erb’s palsy treatments below.

Physical Therapy

One of the main treatment methods for brachial plexus palsy is physical therapy.

This therapy helps to improve stiffness and immobility in a child’s arms or shoulders. Therapists will use massage techniques, motion exercises, and exercise equipment to improve movement and strength in the affected arm.

Babies can start home physical therapy as early as 3 weeks old.

Occupational Therapy

Occupational therapy is often used in cases of Erb’s palsy that have not improved on their own after 2 to 4 months.

Occupational therapy can help a child develop the strength to perform everyday activities, such as picking up a toy or bottle. An occupational therapist will use a range of movement exercises to improve joint function and muscle tone.

Surgery

Children with severe cases of Erb’s palsy will usually require surgery to repair nerve damage and paralysis in the arm, hand, elbow, or shoulder. It is important to get surgery as soon as possible since postponing Erb’s palsy surgery can lower the chance of complete recovery.

The main type of surgery used to treat this condition is a nerve transfer. Doctors remove a healthy nerve from another area to attach it to a damaged nerve.

In some cases, a tendon transfer may also be performed. This involves taking a tendon from another part of the body and moving it to the affected arm to improve mobility.

Our team is standing by to learn more about your child’s injury and see if medical negligence is to blame. Speak to one of our experienced nurses today.

Take Legal Action For Erb’s Palsy Today

Doctors, nurses, and other professionals in the delivery room are trained to safely deliver babies without complications. Unfortunately, many instances of brachial plexus palsy are caused by medical negligence and could have been prevented with proper care.

You should not be responsible for paying for your child’s Erb’s palsy treatment if their condition could have been avoided. Thankfully, there are financial aid options available to help your family afford the treatment your child deserves.

You may be eligible for financial compensation through a lawsuit. Get a free case evaluation today to see if you qualify to file a medical malpractice lawsuit.

Erb's Palsy FAQs

What causes Erb’s palsy?

Erb’s palsy is often caused by excessive pulling of the neck or head during childbirth.

There are many factors that can increase the odds of your child developing Erb’s palsy. Some of these risk factors include high birth weight, abnormal pelvic shape, prolonged delivery, and more.

Is Erb's palsy permanent?

Sometimes. Numbness, paralysis, and weakness of the affected muscles may be permanent depending on the type and severity of Erb’s palsy.

The best way to ensure your child makes a full or partial recovery is to seek treatment as soon as possible. Many children are able to regain feeling and strength in the affected arm with treatment.

How do you treat Erb’s palsy?

Erb’s palsy is usually treated with physical therapy, occupational therapy, and/or surgery. The type of treatment your child receives can depend on their specific case, but most children undergo physical therapy to increase the range of motion in the affected arm.

Can you sue for Erb’s palsy?

Yes. You may be able to take legal action against the health care providers that delivered your child if their condition was caused by medical negligence.

The best and only way to know whether you can sue is to contact an Erb’s palsy lawyer. An experienced birth injury attorney can help you file a medical malpractice lawsuit if you qualify.

Get a free case evaluation to see if you can file an Erb’s palsy lawsuit today.

Birth Injury Support Team
kristin proctor registered nurseReviewed by:Kristin Proctor, RN

Registered Nurse (RN)

  • Fact-Checked
  • Editor

Kristin Proctor began her nursing career as a U.S. Army Nurse and has been a Registered Nurse (RN) more than 20 years. She has specialized experience in labor and delivery, as well as prenatal, antepartum, and postpartum care. Kristin uses this experience to educate and support families affected by birth injuries.

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

View Sources
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  2. Brachial plexus injury. (n.d.). Retrieved September 23, 2021, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/brachial-plexus-injuries#:~:text=A%20brachial%20plexus%20avulsion%20occurs,avulsions%20often%20cause%20severe%20pain.
  3. Erb's palsy (BRACHIAL Plexus BIRTH Palsy) - OrthoInfo - AAOS. (n.d.). Retrieved September 22, 2021, from https://orthoinfo.aaos.org/en/diseases--conditions/erbs-palsy-brachial-plexus-birth-palsy
  4. Erb's palsy Causes, diagnosis and Treatment: BAPTIST HEALTH. (n.d.). Retrieved September 22, 2021, from https://www.baptisthealth.com/services/neurology-care/conditions/erbs-palsy
  5. Erb's palsy. (n.d.). Retrieved September 22, 2021, from https://www.physio-pedia.com/Erb%27s_Palsy
  6. Klumpke paralysis. (n.d.). Retrieved September 22, 2021, from https://rarediseases.info.nih.gov/diseases/3123/klumpke-paralysis#:~:text=Klumpke%20paralysis%20is%20a%20rare,the%20lower%20arm%20and%20hand.