What is Erb’s Palsy?
If you found this article by searching for Erb’s palsy online, it is likely that you are the parent of a newborn child who demonstrated some frightening symptoms and received an unfamiliar diagnosis. What is Erb’s palsy? What causes it, how is it treated, and what does it mean for your child?
Erb’s palsy is the result of a nerve injury, usually during the birth process. It happens when a baby is pulled on, causing unnatural stretching of the neck which leads to injury. The injury is to the brachial plexus, which is a network of nerves between the neck and shoulders. These nerves control muscle function in your baby’s shoulder, arms, hands, and chest, as well as feeling in his arms and hands. Palsy means “weakness,” and this type of injury leads to weakness in the arm and hands.
Approximately two babies in a thousand will develop Erb’s palsy, which may also be referred to as shoulder dystocia or brachial plexus palsy.
Symptoms of Erb’s Palsy
You, or the medical staff, may have noticed signs of Erb’s palsy shortly after your baby’s birth. One of the first noticeable signs is an inability to move an arm and shoulder shortly after birth. While newborns do not have much control over limb movement, they do move their arms and legs, so one arm hanging limply at the baby’s side is an indication that something is wrong. Other common signs of Erb’s palsy include:
- Abnormal positioning of arm and hand, especially with arm bent toward body
- Loss of feeling (baby may appear not to notice a poke or scratch in the affected area)
- Absent or weak reflexes
- Weakened grip in affected hand
- Pain (baby may give high-pitched cries when affected area is touched)
- “Waiter’s tip” posturing of affected arm and hand
If you notice any of these symptoms, especially in conjunction with one another, bring them to the attention of your doctor or medical care team immediately. If Erb’s palsy is left untreated, it could lead to permanent numbness and/or weakness in the arm, as well as partial or full paralysis and muscle atrophy. However, if promptly and properly treated, most infants with Erb’s palsy can recover feeling and movement in the affected arm and hand.
Timely physical therapy, and possibly surgery, are key, so don’t keep your concerns to yourself. It is better to find out that there is a problem and to address it than to hope that an issue will go away on its own.
How Does Erb’s Palsy Happen?
Erb’s palsy most commonly occurs during a difficult labor and birth, for instance when the baby’s head is too large for the birth canal. Doctors can usually diagnose this late in the pregnancy and often schedule a C-section, but if not, the baby may be injured when the doctor is trying to facilitate the birth. The disproportionate size of the infant’s head may cause the shoulder and head to be pushed in different directions as the infant squeezes through the birth canal.
During head-first deliveries, a baby’s head may emerge from his mother’s dilated cervix, but then the baby is stuck in the birth canal. The obstetrician may manually pull on the baby or use a vacuum extractor, causing the brachial plexus injury. Erb’s palsy can result from a breech (feet-first) delivery, too, in which the obstetrician must necessarily pull the baby out by his or her feet, risking shoulder dystocia.
In many cases, a doctor should be able to anticipate complications, especially if the baby is large, and may choose to schedule a C-section to avoid those complications. It should be noted that in very rare circumstances, lateral traction during a C-section can lead to injuries that cause Erb’s palsy, but the risk is still lower than the risk of Erb’s palsy from a complicated vaginal birth.
In some cases, brachial plexus injuries are unavoidable, but in many others, they are the result of medical malpractice.
Treatment for Erb’s Palsy
The course of treatment for an infant with Erb’s palsy will depend on the severity of the condition, which may range from mild to severe. In mild cases, the condition may resolve on its own, and a doctor may recommend simple therapy exercises and watchful waiting. In more severe cases, surgery may be required, and, very rarely, nerve transfers or nerve grafts. While most babies with Erb’s palsy make a full or nearly full recovery, some with the most severe injuries, or who do not receive timely treatment, may have permanent effects.
The information in this blog post is provided for informational purposes only and is not intended to be legal advice. You should not make a decision whether or not to contact a qualified medical malpractice attorney based upon the information in this blog post. No attorney-client relationship is formed nor should any such relationship be implied. If you require legal advice, please consult with a competent medical malpractice attorney licensed to practice in your jurisdiction.