Erb’s Palsy

Erb’s Palsy

Article
Bone, Muscle, & Joint
Kids' Zone
+1
Contributed byMaulik P. Purohit MD MPHJul 01, 2019

What are the other Names for this Condition? (Also known as/Synonyms)

  • Brachial Palsy
  • Erb-Duchenne Paralysis
  • Upper Brachial Plexus Paralysis, Erb-Duchenne Type

What is Erb’s Palsy? (Definition/Background Information)

  • The brachial plexus is a system of nerves that begins within the cervical region of the neck and runs down the shoulder. These nerves, which arise from the spinal cord, control muscle movements in the shoulder, arm, hand, and fingers
  • Erb’s Palsy is characterized by a loss of movement or weakness in the arm, which results when the collection of nerves surrounding the shoulder is damaged, during childbirth
  • The condition may occur when an infant’s neck is stretched, during a complicated delivery. The damage is caused, either after delivery, or just prior to delivery
  • Both nonsurgical and surgical methods treatment measures are available to treat Erb’s Palsy

Who gets Erb’s Palsy? (Age and Sex Distribution)

  • Erb’s Palsy may occur in children of all races, ethnic groups, and gender
  • The condition occurs very early in infants, resulting from a trauma to the brachial plexus nerves, during childbirth

What are the Risk Factors for Erb’s Palsy? (Predisposing Factors)

Common risk factors associated with Erb’s Palsy include:

  • Mother’s prior history of delivering larger babies. Large babies are a complication of gestational diabetes in the mother
  • Mother’s prior history of prolonged or delayed deliveries
  • Medications that induce labor, resulting in stronger contractions
  • Administration of epidural anesthesia, during labor
  • Gestational diabetes

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Erb’s Palsy? (Etiology)

  • The exact cause of Erb’s Palsy during childbirth, is unknown. The use of forceps in a delivery could result in Erb’s Palsy, as a complication
  • Nevertheless, it is important to note that not all deliveries that use forceps will result in the disorder. In fact, Erb’s Palsy is a rare complication of a forceps delivery

Factors that could cause Erb’s Palsy include:

  • A prolonged and complicated delivery
  • Babies, who are delivered feet first; breech delivery
  • Delivery of a large baby
  • Shoulder dystocia: Presence of shoulder dystocia in babies at birth, increases the chances of Erb’s Palsy

What are the Signs and Symptoms of Erb’s Palsy?

Most signs and symptoms associated with Erb’s Palsy are noticeable immediately after childbirth. These include:

  • Arm and shoulder weakness that limits the infant’s range of motion of the arm/shoulder
  • Abnormal bending of the arm towards the body
  • Paralysis of the arm

How is Erb’s Palsy Diagnosed?

Diagnostic methods that a physician may use to help diagnose Erb’s Palsy include:

  • Physical examination: A thorough physical examination is important in determining if Erb’s Palsy has occurred. During the exam, a pediatrician will ask the parent or guardian the symptoms, the infant has exhibited. In addition to this, the physician will assess the child’s complete birth medical history to arrive at a diagnosis
  • X-ray of shoulder joint: X-rays use radiation to produce images of the soft tissues and bones. Occasionally, an x-ray of the collarbone may be required, to determine if a fracture has occurred
  • Magnetic resonance imaging (MRI) of shoulder joint: An MRI is a more detailed scan that uses radio waves and a magnetic field to produce images that allow a physician to view any damage to the bones and soft tissue, which surrounds the brachial plexus nerves
  • Electromyography (EMG): An EMG shows the electrical activity of the muscle during rest and contraction. Examining the electrical activity may help a physician study and identify any muscle or nerve disorders
  • Nerve conduction velocity (NCV) test: Occasionally, a nerve conduction velocity test is necessary in examining the speed at which the electrical signals move through a nerve. Slowing of the nerve conduction speed may help identify, if nerve damage is the direct result of a birth trauma

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Erb’s Palsy?

A majority of Erb’s Palsy cases are temporary and resolve on their own. However, severe cases of Erb’s Palsy may result in avulsion (tearing away), which occurs, when the brachial plexus nerve separates from the spinal cord.

How is Erb’s Palsy Treated?

The treatment for Erb’s Palsy includes both nonsurgical and surgical methods.

  • The main treatment associated with Erb’s Palsy is daily physical therapy. Since, infants cannot move the affected arm by themselves; a parent must take an active role in their child’s physical therapy program. Daily physical therapy and motion exercises should be performed, when the child is around 3 weeks old. A physical therapist may also recommend additional exercises, to aid in treating the condition
  • In many cases, Erb’s Palsy heals immediately without the requirement of any therapy. Close clinical monitoring may be necessary during the initial stages. However, surgery may be considered, if strength in the affected muscles has not returned, by the time the child is 3-6 months old
  • Surgery for Erb’s Palsy produces the best result, if performed when the child is between 3-6 months old. Studies have established that direct surgical intervention to repair the brachial plexus nerve, is not quite successful, the later it is performed
  • In many cases, microsurgical techniques are recommended to repair the brachial plexus injury. This technique has shown to have better recovery rates
  • Exploratory surgery can involve nerve grafting, which is a minimally invasive surgical technique. In this technique, a segment of unrelated nerve (from another part of the body) is used to replace, or bridge the damaged section of the nerve
  • Other surgical methods for Erb’s Palsy may involve neurolysis (breaking-down of nervous tissue) and nerve decompression; although, both methods are shown to achieve less significant results

How can Erb’s Palsy be Prevented?

The prevention of Erb’s Palsy, continues to be the goals of obstetricians, given the fact that a high percentage of the cases that occur during childbirth, are preventable.

  • If identifiable risk factors are present during childbirth, these must be taken into consideration and care must be taken to prevent Erb’s Palsy occurrence
  • Consequently, early detection and proper treatment of risk factors, is important in avoiding Erb’s Palsy

What is the Prognosis of Erb’s Palsy? (Outcomes/Resolutions)

  • The long term prognosis of Erb’s Palsy is usually good for a majority of the infants
  • Physicians, usually recognize the occurrence of Erb’s Palsy, during the delivery process. However, it may take a few months after childbirth, to recognize the extent of the condition
  • Erb’s Palsy resolves completely in approximately 70-80% of the children, who are treated within the first 4 weeks of childbirth
  • However, some severe cases of the condition may require over 12 months of treatment. If the condition is even more severe, then it may result in a permanent paralysis

Additional and Relevant Useful Information for Erb’s Palsy:

  • Approximately, 1 out of every 1,000 infants, develop Erb’s Palsy following childbirth

The following article links will help you understand fractured clavicle in a newborn.

http://www.dovemed.com/diseases-conditions/fractured-clavicle-in-a-newborn/

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Maulik P. Purohit MD MPH picture
Approved by

Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team

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