Erb’s Palsy

G U I D E

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Erb’s palsy can be different for every child and can range in severity from mild,
temporary injury to permanent nerve damage. This guide provides information on
Erb’s palsy, including causes, diagnosis, prognosis, treatment options, and more. With
this information, parents and caregivers can better identify the signs of Erb’s palsy and
determine next steps.

What is Erb’s palsy?

Erb’s palsy (also known as Erb-Duchenne palsy or brachial plexus palsy) is a birth injury
caused by damage to the brachial plexus network of nerves during childbirth.

The brachial plexus is a network of nerves that runs down the spine. This
group of nerves connects the neck and torso areas of the spinal cord
to the arm. 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.

According to the American

Academy of Orthopedic Surgeons
(AAOS), 1 out of 1,000 babies is
born with Erb’s palsy.

Brachial plexus 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. Klumpke’s palsy 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.

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What causes Erb’s palsy?
Erb’s palsy is often caused by excessive pulling or stretching of an infant’s head, neck, shoulders,
or arm during a difficult or prolonged delivery. Erb’s palsy can develop if an infant’s head and neck are
pulled to the side when the shoulders pass through the birth canal.

Many cases of Erb’s palsy are preventable and

caused by mistakes during the birthing process.

During difficult childbirths, doctors may have to move quickly to

deliver the baby and may exert extra force to remove the child
from the birth canal. This can stretch the baby’s neck and may
result in Erb’s palsy.

Erb’s palsy can also develop 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.

There are also certain risk factors that may increase the odds of a child developing Erb’s palsy.

Risk factors of Erb’s palsy include:

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

• Maternal diabetes • Other forms of medical negligence

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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. Symptoms can vary depending
on the type of Erb’s palsy present.

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

Neuroma
Neuromas are more severe than neuropraxias. When neuromas occur, scar tissue forms during
the healing process 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 on their own. 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, a condition that causes drooping eyelids,
small pupils, and other eye-related symptoms.

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

The best and only way to learn which type of brachial palsy your child
may have is to consult with a doctor. From there, your doctor can
determine the best course of action for treating your child.

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Erb’s palsy symptoms
Erb’s palsy symptoms can differ for each Common Erb’s palsy symptoms include:
child. However, symptoms of Erb’s palsy
usually only affect one side of a newborn’s • Limp arm
body. • Muscle weakness
• Numbness
The majority of Erb’s palsy symptoms • Partial or complete paralysis of the arm
are often mild and go away with time.
• Reduced grip ability
However, because Erb’s palsy has varying
• Waiter’s tip (dangling arm with fingers
degrees of severity, some children will
curved upwards)
experience more intense and permanent
symptoms.
Mild Erb’s palsy symptoms include:
Mild Erb’s palsy symptoms
• Burning sensation
A child can develop mild Erb’s palsy • Muscle weakness
symptoms when the brachial plexus nerves
• Numbness in affected arm
are stretched during their birth. Mild types of
Erb’s palsy stretch injuries include neuromas
and neuropraxias.
Severe signs of Erb’s palsy include:

Severe Erb’s palsy symptoms • Complete or partial paralysis in the

affected arm
Some rare cases of Erb’s palsy can be more • Muscle weakness
severe and can result in a wider variety of
• Significant loss of motion in the shoulder,
symptoms.
arm, hand, and/or fingers

Ruptures and avulsions are the most severe

types of brachial plexus injuries and cause
Other long-term effects of Erb’s palsy
more intense Erb’s palsy symptoms since
include:
they occur when the nerves and/or nerve
roots are torn and cannot heal on their own.
• Contractures (tightened muscles, joints,
or tendons)
In rare cases, Erb’s palsy symptoms
can cause several long-term effects and • Infant torticollis (stiffness of the head or
coexisting conditions due to the brachial neck)
plexus nerve damage. • Muscle atrophy
• Stiff joints
• Numbness

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Erb’s palsy diagnosis
If your child is showing symptoms of Erb’s palsy,
Common imaging scans used to
it is important to contact a doctor as soon as
diagnose Erb’s palsy include:
possible to get a proper diagnosis.

A doctor will generally conduct a physical • CT (computed tomography) scans:

examination to check for any obvious signs of Computerized X-rays that give doctors
more detailed images of muscles,
nerve damage.
nerves, bones, and other interior
structures
Then, your doctor will use a variety of imaging
tests to diagnose Erb’s palsy. • MRI (magnetic resonance imaging)
scans: Conducted with radio waves
Most MRIs and CT scans take a few hours to and magnetic fields to find injured
complete and often provide doctors with enough nerves and determine the extent of the
information to make a diagnosis. However, some damage
doctors may order other tests, such as an X-ray,
electromyography, or a nerve conduction study.

When conducting imaging tests,

doctors generally search for:

• Completely torn nerve from the spinal

cord (avulsion)
• Scar tissue on the nerve (neuroma)
• Stretching of the nerve (neuropraxia)
• Tears in the nerve from stretching
(rupture)

Once a diagnosis has been made,

doctors can determine the best
treatment plan to help your child
make a partial or full recovery.

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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.

The most common forms of Erb’s palsy treatment are

physical therapy, occupational therapy, and surgery. All of
these treatment options aim to regain overall mobility and
function of the affected limb.

Physical therapy

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

Erb’s palsy physical therapy can start as early as

These guidelines include the following:
two weeks after the child is born, and physical
therapy at home can start a week after that. In
these cases, the treatment is typically conducted • Allow time for any inflammation from
with a licensed physical therapist on a weekly or the birth injury to settle down
biweekly basis. • Do not lift a child under the arms
• Protect the affected arm by carefully
However, if your child is diagnosed at birth, your handling the baby
medical provider will likely provide you with a list • When dressing the child, place the
of guidelines for handling your child so that you affected arm into the sleeve first, then
do not harm their affected arm before they start the head and the unaffected arm
therapy.

Many children with Erb’s palsy are able to partially or fully recover
with physical therapy.

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Erb’s palsy physical therapy can help relieve
Physical therapy treatment usually
stiffness and return range of motion to the child’s
involves the following:
affected arm. Physical therapists will use several
different range-of-motion exercises, equipment,
and massage therapy to help babies regain • Adaptive equipment like splints to
strength. prevent contractures
• Daily home-based stretching and
Physical therapy treatment techniques can vary exercise
depending on the child’s specific needs and
• Gentle passive motion of joints
severity of the injury. The physical therapist may
provide parents with additional physical therapy • Monthly follow-up at a clinic
instruction to complete at home as well. • Weekly or biweekly formal physical
therapy
Physical therapists and your child’s doctor can
also recommend changes to the therapy routine
(if needed) as the child’s treatment moves
forward.

Occupational therapy Occupational therapy can help children

complete daily activities such as:
Occupational therapy is often used in cases of
Erb’s palsy that have not improved on their own • Bathing
after 2 to 4 months.
• Brushing teeth/hair
• Drawing
Occupational therapy can help a child develop
the strength to perform everyday activities, such • Drinking from a cup
as picking up a toy or bottle. An occupational • Eating with utensils
therapist will use a range of movement exercises • Getting dressed
to improve joint function and muscle tone. • Writing

The overall goal of occupational therapy is

to help children with Erb’s palsy become
as independent as possible. Starting
occupational therapy early may improve the
quality of life for those affected.

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Surgery

Children with severe cases of Erb’s palsy will

Erb’s palsy surgery options include:
usually require surgery to repair nerve damage
and paralysis in the arm, hand, elbow, or • Bone remodeling
shoulder. It is important to get surgery as soon
• Muscle lengthening
as possible since postponing Erb’s palsy surgery
• Muscle transfers
can lower the chance of complete recovery.
• Nerve grafts
Some children with more severe cases of Erb’s • Nerve reconstruction/reconnection
palsy may require surgery alongside physical and • Nerve transfers
occupational therapy to repair damaged nerves.
The goal of these surgeries is to help the child
regain range of motion and control of the affected
shoulder, upper arm, wrist, and/or hand. There
are several different surgery options depending
on the child’s needs.

Although surgery is successful for most patients with severe cases of

Erb’s palsy, it can take several months for a child to regain full control of
the muscles in their arm and lower hand.

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Erb’s palsy prognosis
Thankfully, many cases of brachial plexus palsy do not have long-lasting consequences. Most mild
cases of Erb’s palsy usually resolve on their own around three months of age and do not have a
long-lasting impact on a baby’s overall development.

Further, most babies diagnosed with Erb’s palsy will recover movement and feeling in the affected
arm with daily physical therapy treatment, according to the American Academy of Orthopaedic
Surgeons (AAOS).

However, there are many cases where Erb’s palsy does not heal on its own. Sometimes, serious
cases of Erb’s palsy will require surgery to help restore functioning in the arm or hand.

Most mild cases of Erb’s palsy usually resolve on their own around three months of age and do not
have a long-lasting impact on a baby’s overall development.

According to a study by
Dalhousie University and
the IWK Health Centre
in Canada, 80% to 90%
of all children diagnosed
with Erb’s palsy make a
full recovery.

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How can I find treatment for
my child?

Finding the right

treatment for your child
is essential in giving
them the best chance
at a full recovery from
Erb’s palsy.

If your child is showing any signs

of Erb’s palsy, you may wonder how
to seek medical help to get them a
diagnosis.

We understand how important it is to

get your child the best possible care.
Our team at Cerebral Palsy Guide can
connect you with resources you need to
help your child overcome an Erb’s palsy
diagnosis.

Our team can help you:

Your child deserves to live a pain-free,
independent, long, and happy life. We
• Find a doctor to get a diagnosis
are committed to connecting your family
with every resource available to ensure • Learn about effective treatment methods
that your child receives the care they • Connect with emotional support resources
need. • Research financial assistance options

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Erb’s palsy support and
resources
When your child has been diagnosed with Erb’s palsy, it can be difficult to know what actions to take
and where to turn for support and guidance. Here are a few resources you may find useful.

Facebook Groups:
There are several Erb’s palsy support groups on Facebook that provide a dedicated space for
parents, families, and caregivers to share their experiences.

United Brachial Plexus Network (UBPN):

This nonprofit organization provides information, support, and leadership to families and those
concerned with brachial plexus injuries across the globe. It also provides guidance on physical
therapy you can do at home.

United Spinal Association:

In this blog post, Ellie Smith, a student teacher who was born with Erb’s palsy, shares some advice
for parents of children who have similar disabilities.

Call us at (855) 220-1101 to learn more.

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