Erb’s Palsy (Brachial Palsy)

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Warning Signs

These nerves allow for movement and feeling in the arms, hands, and fingers. The condition differs from cerebral palsy in that Erb’s is not caused by a brain injury or abnormality. Erb’s palsy is sometimes referred to as brachial palsy, Erb-Duchenned paralysis, or Klumpke paralysis. Erb’s palsy is generally the result of a nerve injury during a difficult birth and delivery. About one to two in every 1,000 deliveries will result in a brachial nerve injury. These nerves can be injured if the baby’s neck or head is stretched to the side during delivery. Excessive pulling on the shoulders as the baby is being delivered head first can also lead to brachial nerve injury.

During feet-first births (breech), the baby’s arms are usually raised and can be injured from excessive pressure.

A weakness or paralysis of the arm is often associated with Erb’s palsy, but it is important to note that the disorder can cause varying amounts of impairment. The varying names of this condition signify the level of impairment. Brachial plexus injuries occur when only the upper part of the arm is affected. Erb’s paralysis is considered appropriate terminology when the injury impairs moving the upper arm and rotating the lower arm. If the condition affects the hand, it is referred to as Klumpke paralysis. Improved delivery techniques prevent many brachial nerve injuries from occurring, but larger than average babies (birth weight of more than 8 pounds, 13 ounces) are still at a greater risk for these type of birth injuries. Breech births also put babies at a greater risk.

Diagnosis & Care

A pediatrician is generally the medical provider that will make a diagnosis of Erb’s or brachial palsy, based on observance of arm weakness. The physician may order an x-ray to determine the extent of damage to the bones and joints in the neck and shoulder. Most cases of Erb’s palsy are caused by stretching of the nerves and heal within six to twelve months after delivery; stretching can temporarily harm the nerve, but it rarely causes permanent damage. If the stretching causes scar tissue to form around healthy nerves, total recovery is less likely. If the nerves are torn completely, the prognosis is much more serious, and in these situations, the nerves are unlikely to completely heal on their own. In very rare instances the nerve can be torn apart from the spinal cord, which is referred to as avulsion.

Erb’s palsy can usually be identified immediately after birth, but the extent of the injuries may not be fully realized until months after the baby is born. Babies with Erb’s palsy may lack a Moro reflex on the injured side of their body. A Moro reflex occurs when an infant is startled; a healthy newborn who is startled will throw their arms out to the side with their palms up and thumbs flexed. A started infant with Erb’s palsy may hold the injured arm tight against their body with their elbow flexed. The affected limb may have minimal to no spontaneous movement, a lack of strength in the grip, or delayed development and growth.

Expenses

The costs associated with treatment and surgery for Erb’s palsy can be substantial. In addition to medical costs, families often have to commit a large amount of resources to help the injured child recover and minimize lasting limitations. Erb’s palsy is sometimes the result of medical error, which means that the injured child’s family may be eligible for compensation for the pain and suffering as well as the additional medical expenses incurred as a result of the injury.

If you believe your child’s birth injury is a result of medical error, contact the medical malpractice lawyers at the Law Offices of Wais, Vogelstein, Forman & Offutt for a free consultation.

Treatment Centers

Between 80% and 90% of children with brachial nerve injuries will attain normal or near normal functioning over time. In cases of stretching or minor tears, Erb’s palsy will generally heal on its own, but a baby should receive physical therapy or occupational therapy so that the limb does not stiffen. Physical therapy may involve gentle massage and range of motion therapy to keep the muscles strong. Treatment may also include splinting or casting the affected arm.

If the injury is more severe and involves more extensive nerve damage, surgery may be necessary. If the nerves are unable to function properly, a tendon transplant may be appropriate. Surgery options are generally not discussed until a baby is between three and six months old, and even with surgery, nerve injuries heal very slowly and can take up to two years to completely heal. In the most severe situations, the affected arm may always be weak and have limited range of motion.

Books & Resources

For more information on Erb’s palsy and brachial palsy, the following resources are available:

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