Erb’s Palsy is an injury to the nerves of the brachial plexus that control the movements of the hand, arm and shoulder. This injury is typically caused by improper pulling on a baby’s head during delivery resulting in stretching and sometimes tearing of this nerve bundle. However, Erb’s Palsy can also occur to adults who undergo surgical procedures and end up with an inability to raise their arm or use their hand. Injury during surgery can occur when the patient’s arm is improperly positioned on the operating table and pressure or stretch is put on the nerve. The brachial plexus can also be injured directly when surgery is performed on the neck and the nerve is cut or severed by scalpel or the use of the electrocautery. Injury can occur if surgeons or nurses inadvertently lean against the patient’s arm for a prolonged period of time causing pressure ischemia to the nerves.
Erb’s palsy injuries can be so severe that working and performing even the simple activities of daily life are not possible. The brachial plexus is a bundle of nerves coming from the C5, C6, C7, C8 and T1 nerves in the cervical spine that provide motor and sensory function to the upper extremity. Complete avulsion of the brachial plexus causes complete loss of function in the arm, while lesser injuries cause partial loss of function in the arm and hand. If the injury is severe enough, surgery can be performed to try to repair the damaged nerves. In other cases, surgeons can try to transpose other muscles to replace the nonfunctioning ones.
Although adult Erb’s Palsy injuries are associated with cervical lymph node dissections and from spinal surgery when the surgeon and/or the assistant directly injuries the nerve plexus, they can also occur when surgery is done on areas far away from the neck area. Injuries to the nerves can occur during appendectomies and even orthopedic operations on the leg, if the patient’s arm is not properly positioned or protected during the operation. While Erb’s Palsy is traditionally considered a newborn birthing injury, adult brachial plexus injuries are not uncommon. Careful evaluation of the medical and surgical record is important in determining if such injuries were caused by improper surgical technique or positioning.