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.
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.
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: