Erb’s Palsy Causes, Symptoms, and Treatment Options

Erb’s palsy is the most common birth neurological injury. It is a paralysis of the arm caused by damage to the upper groups of the main nerves that supply the shoulder and arm.

What are the causes of Erbs’ palsy?

The most common cause of Erbs’ palsy is damage to the nerves during childbirth. In case of a difficult delivery such as a baby’s shoulder getting stuck in the pelvis or in a breech position where pressure may be applied to the arm the nerves of the upper limb get stretched and may be damaged.

The extent of pressure applied determines the stretching and hence the damage caused which may vary from minimal stretch to occasional tearing of the nerves though this rarely occurs.

What are the risk factors for Erbs’ palsy?

Some of the risk factors that may predispose the child to Erb’s palsy are shoulder dystocia, large for gestational age, forceps delivery, breech presentation, prolonged labor, and multipara mother.

Spotting that your child has Erb’s palsy??

Decreased movements of the arm: The neonate may have his arm hanging limply from the shoulder, cannot be raised from side to side, and the affected arm may not move as actively as the other.
Abnormal position of the upper limb: The shoulder may be tucked to the sides with no movement at the elbow joint and the palm facing backward, the characteristic appearance is also called a waiter tip posture.
Loss of sensation: If the baby does not respond to touching, squeezing, or other environmental factors such as heat or cold, this could be a sign of nerve damage.
Abnormal reflexes: Children with Erb’s palsy lack the typical neonatal reflexes such as more reflex, and pinch reflex though present may be impaired.

How to diagnose Erb’s palsy??

Mainly Erbs palsy is diagnosed clinically but in rare instances when the Erbs palsy fails to show signs of improvement, imaging techniques such as MRI of the brachial plexus and cervical cord can be done. NCV or EMG can sometimes request to assess the status of electric stimulus to a particular nerve.

Erb’s palsy treatment:

Managing Erb’s palsy is mainly dependent on the severity of the damage to the nerves. In the majority of the cases, the condition is resolved by physiotherapy alone. It is recommended to begin active and passive stretching along with hydro and occupational therapy.
The key to treatment is maintaining passive motion while nerve function returns.

What to expect/ prognosis in a child with Erb’s palsy??

Erb’s palsy carries a favorable prognosis if the biceps and deltoid can move actively, and the child can do antigravity movements by the age of 3 months although complete recovery might take up to 2 years.

If the muscles remain reinnervated, however, till the age of 18-24 months then the damage becomes irreparable and surgical intervention may be required. The prognosis for babies with Erb’s Palsy can vary. Many infants recover fully with proper treatment and time, while others may have lingering effects. Think of it like a sprained ankle: with care and rest, most recover completely, but some might experience lasting discomfort. Regular follow-ups with healthcare providers can ensure the best outcomes.

Are there any surgeries for Erbs’ palsy?

Depending upon the age of the presentation, if the child is less than a year old, nerve transfer or grafts may be attempted.

In case of irreversible nerve damage, the surgical interventions are mainly aimed at correcting associated deformities of the shoulder, elbow, and wrist and may involve tendon transfer, lengthening, and bony procedures.

Conclusion

Erb’s Palsy in newborns can be a challenging condition, but awareness and early intervention can make a significant difference. If you suspect your baby may be affected, don’t hesitate to seek help. Remember, knowledge is power, and understanding this condition can lead to better support and recovery for your little one.