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Erb’s Palsy Overview
Erb’s palsy is among the birth injuries that a baby may incur during a difficult delivery.
Named for Dr. Wilhelm Erb who first determined the mechanics of the condition, Erb’s palsy is a form of brachial plexus birth palsy. Among the many networks of nerves in the body is the brachial plexus, a bundle of nerves near the shoulder that connects and distributes nerves from the neck down to nerves in the arm.
Damage to the brachial plexus may affect movement or feeling in the shoulder, arm, hand or fingers on the side of the body that suffers trauma. This occurs most often when a baby’s neck is stretched to one side due to a complicated delivery.
In some cases, an infant’s arm will appear to be rotated in toward the body. In other cases, the arm appears to hang limply from the shoulder with the wrist and fingers flexed, a condition nicknamed “waiter’s tip hand.”
Large babies are most at risk for Erb’s palsy, often due to a mother’s gestational diabetes. Other risk factors include either an extremely short or very prolonged second stage of labor or a baby who is breech.
The affected arm is usually immobilized for the first week, but active and passive range of motion exercises with the help of a parent are often recommended in the following weeks. The wrist and fingers might benefit from being splinted to prevent flexing contractions.
When just the upper nerves are affected, the infant might not have control of shoulder movement, but can still move the fingers, which is an indication of true Erb’s palsy. If both the upper and lower nerves become stretched and damaged, the term is total or global brachial plexus birth palsy.
Erb’s Palsy and Similar Birth Injuries
According to Boston Children’s Hospital, the brachial plexus can become injured during birth in a variety of ways.
- Erb’s palsy specifically affects the upper portion of the brachial plexus, including the C5, C6 and sometimes C7 nerves that affect the muscles of the shoulder and biceps. Boston Children’s Hospital recommends physical therapy at home when the baby is three weeks old. This intervention will keep the joint from becoming stiff, prevent muscle atrophy and prevent the shoulder from dislocating.
- Total plexus involvement affects all five nerves, from C5-T1, and may prevent the child from moving the shoulder, arm or hand at all. Fewer than 30 percent of brachial plexus injuries fall into this category.
- Horner’s syndrome involves injuries to the nerves in the sympathetic chain. Symptoms include a drooping eyelid, smaller eye pupil, and an inability to sweat properly from portions of the face. Up to 20 percent of brachial plexus birth injuries are Horner’s syndrome cases, and most involve avulsion, which means the nerve roots are torn from the spinal cord.
- Klumpke’s palsy is rare in infants, and affects only the lower nerves of the brachial plexus, causing issues with the muscles of the hand on the injured side.
Often, serious birth injuries such as Erb’s palsy that were incurred during a baby’s birth could have been prevented.
