Erb’s Palsy

What Is Erb’s Palsy?

Erb’s palsy, also known as Erb-Duchenne paralysis or brachial plexus birth palsy, is an injury during birth to the nerves that innervate the baby’s arm and shoulder. It is one of the most common neurological birth injuries. Erb’s palsy is caused by stretch and avulsion injuries to the brachial plexus nerves during birth. This is caused when an obstetrician pulls on the baby’s head when the shoulder has difficulty being delivered, as with shoulder dystocia. This activity can cause nerve damage that results in Erb’s palsy.

The brachial plexus innervates all muscles of the arm and shoulder except the trapezius muscle (which extends from shoulder to shoulder across the upper back). Erb’s palsy occurs when the upper trunk of the brachial plexus, comprising cervical nerves 5 and 6 are injured. Erb’s palsy can also involve injury to the C7, C8 and T1 nerves. Damage to these nerves will affect the baby’s fingers, wrist or arm, and T1 injury could affect breathing.

What Are Common Causes Of Erb’s Palsy?

Common causes of Erb’s palsy stem from macrosomia, gestational diabetes, and obesity. These conditions contribute to increased risk of having a baby whose shoulder can get stuck during delivery. The brachial plexus can get stretched if the baby can’t pass out of the birth canal and the baby’s shoulders becomes wedged against the mother’s pelvic bone and a doctor try to use force to pull the baby out. Additionally, a lengthy second stage of labor (over an hour), small or abnormal maternal pelvis shape, and use of assistive delivery tools can contribute to Erb’s palsy.

Excessive traction to pull the baby out when the shoulder is stuck without using proper maneuvers stretches the nerve and can even tear it from its roots. Early recognition of at-risk babies and proper management during prenatal care and childbirth are necessary to prevent Erb’s palsy.

What Are The Symptoms Of Erb’s Palsy?

Symptoms of Erb’s palsy—a type of brachial plexus injury—may include a limp or paralyzed arm; lack of muscle control in the arm, hand, or wrist; and loss of sensation in the affected arm or hand. The severity of this injury is determined by the type of damage done to the brachial plexus nerves.

The most severe type, avulsion, happens when the nerve root is severed from the spinal cord from traction causing the nerves to stretch.  Most babies with shoulder dystocia that end up with Erb’s palsies are from overstretching of the C5–6 nerve roots during the difficult shoulder delivery.

If Erb’s palsy is suspected, an MRI of the brachial plexus is one of the best ways to identify the extent of the injury and identify the affected nerves.

Are There Lasting Effects Or Complications With Erb’s Palsy?

The lasting effects of Erb’s palsy depend on the nerve injury’s severity. In more severe cases, weakness or paralysis of the affected arm or function of the hand may be a lifelong complication.

In the most severe avulsion cases, nerve graft surgery is the typical treatment; this is done to try to reconnect the nerve. When diagnosed early, Erb’s palsy can be completely resolved within the child’s first year of life if recovery begins within four weeks. However, if the damaged nerve is not reconnected in time, the injury becomes irreversible at 18 to 24 months. Long-term complications of Erb’s palsy are impairments to bone growth, osteoarthritis, reduced muscle strength and stamina, atrophied muscles, discrepancies in limb length, abnormal joint function and movement, and impaired balance and coordination.

Some Erb’s palsy injuries, however, heal without treatment and without complications. Other treatments for Erb’s palsy and other brachial plexus injuries include physical and occupational therapy.

An Experienced Birth Injury Attorney Is Important

If you believe your child’s Erb’s palsy may have been caused by mismanagement of shoulder dystocia during birth, it is essential that you work with an experienced birth injury attorney. At Britcher, Leone & Sergio, our NJ Erb’s palsy lawyers have the expertise needed to look for risk factors that could have predicted shoulder dystocia, necessitating maneuvers to avoid an Erb’s palsy injury. They know that errors in recognizing shoulder dystocia risk factors during prenatal care and failing to utilize appropriate maneuvers during delivery are often under-described in medical records. As experienced birth injury and Erb’s palsy lawyers, they can help parents determine if their child’s injury was caused by negligence.