Erb’s Palsy

Erb's PalsyErb’s Palsy affects the nerves within the neck that control the motions of the arm. The condition turns muscles inward toward the body, disrupting mobility. It can occur during delivery if a baby’s neck is stretched unnaturally as the head and shoulders pass through the birth canal. Early bodily trauma in the first few months of life may also lead to the condition. The name itself comes from the doctor who first documented the condition.

The word palsy refers to the weakness in the arm – not paralysis. Erb’s palsy symptoms have been known to improve or even clear up  on their own. While most cases are mild, each child will have different reactions to the nerve damage. Therefore, each child may require different kinds of treatments. For example, some families may just need a few simple home remedies. Other, more severe cases may require grafting surgery. This surgery can help the patient regain some mobility.

What Is Erb’s Palsy?

Erbs palsy affects a portion of the “brachial plexus.” The brachial plexus stems from the spinal cord. It is located in the arm and between the bones of the neck.  The nerves in your body form a complex path of communication. Erb’s palsy disrupts this flow.

There are nerves in the top of the neck that provide flexibility and support to the arm. The condition occurs when they are cut off from the main trunk of nerves.

Different nerves in the lower portion of the neck control feeling and flexibility in hands and fingers. This is why you may see babies who can’t move the upper part of the arm, but can wiggle their fingers. When the paralysis affects the full arm, hand, and fingers, it’s called global brachial plexus palsy.

Important Things to Know About Erb’s Palsy

Approximately one in a thousand babies will be born with this condition.

Parents and caregivers will play a large role in just how much it affects the child later. If the nerves have only been superficially damaged,  it may just take time or light physical therapy to heal. More serious injuries that involve a tear or rip may need intense therapy and surgery.

Types of Erb’s Palsy Injuries

Erb palsy can happen when a nerve is stretched, torn, or damaged. In severe cases, the nerve will separate entirely from the spinal cord. The symptoms a child experiences are determined by the type of injury.

Neurapraxia

Neurapraxia is both the easiest to deal with and the most common. It occurs when a nerve is stretched. The condition will send burning pain through the affected area. The good news is that it can heal all on its own as the nerve adjusts and goes back to its original position. The difficulty is that the child may experience extreme discomfort during this time. The nerve self-corrects in about three months. This means the child will likely have full range of motion and develop normally.

Neuroma

Neuroma also stretches out the nerve. In this case, the damage is serious enough to leave scar tissue. The child will still experience the same shocking or burning sensations. These travel up and down the length of the nerve. The nerve will heal in much the same way. However, the weight of the tissue will affect the stability of the healthy nerve. It is not possible to recover fully from the extra weight.  Physical therapy or surgery to remove the tissue can give more fluidity to movements.

Rupture

A rupture will tear the nerve rather than stretch it. and This will not be able to correct itself. The child will need a professional to treat it properly. He or she will likely splice and graft a different nerve from a healthy muscle in the infant’s body. This will give the child back some feeling, flexibility, and support. There will, however, be challenges ahead with further development.

Avulsion

An avulsion is the worst type of Erb’s palsy. In this case, the nerve is torn completely away from the spinal cord. Reattachment is not an option. This can cause the arm to be rendered completely motionless. However, some patients with avulsions have been given back a degree of motion after grafting surgery.

Causes of Erb’s Palsy

A child can be pulled and stretched in a variety of ways during delivery. It can be difficult for professionals to predict how the child’s body will react to the actual birth. If the child has his or her head turned to one direction while passing through the birth canal, the arm may be pulled the other way. If the baby comes out face-first, the shoulder may be unnaturally pulled during birth. Often, this will happen if the child is much larger than the birth canal itself.  This is why small mothers are more at risk.

It should be noted that, while it’s most likely to occur during delivery, Erb’s Palsy can also be the result of any type of major trauma such as physical blows or pressure to the neck during the first few months of life.

Erb’s palsy may also occur if the baby is breech. In this situation, the arms will need to be brought over the child’s head so he or she can fit through the birth canal. This can cause dramatic damage as the infant is pulled out by the feet during delivery. Often, the shoulder will be dislocated, too.  The damage may be superficial in some cases. However, there may be stretching or tearing within the brachial plexus during a breech birth.

In some of these difficult deliveries, the child may experience shoulder dystocia. this is when the shoulders have difficulty getting through the birth canal. It may require a good deal of effort to work the baby through. If it takes too long, the child’s life may be in danger as the umbilical cord undergoes extreme compression. However, if the doctor rushes the delivery, there can be extensive damage to the nerves and mobility. Shoulder dystocia is labeled as an emergency and requires someone well-versed in abnormal births. It can occur in up to 1% of deliveries.

Not all of these situations will definitively lead to Erb’s palsy. The chances do increase if the the child has shoulder dystocia.

Erb’s Palsy Symptoms

There are symptoms that parents can look for:

  • Difficulty moving the arm or pain in movement
  • Holding the arm against the body with a bend at the elbow
  • Trouble gripping objects or the fist on one side

The arm does not have to be entirely motionless for the child to have the condition. It may just look weak, be sore or be numb.

The parent may want to test sensory function in the child by placing ice or heat on the affected area. Gently pinching the upper arm to see if the child can feel it can also be a test. If the baby doesn’t react, there could be partial paralysis. Any loss of function or improper development in the circulatory, nervous, or muscular systems can also be a sign. Parents should look for any type of blood flow or motion problems that seem to affect the upper arm.

Erb’s Palsy Risks

Erb’s palsy is not caused by drugs or alcohol use, but rather by some type of problem with the positioning of the baby during delivery. Preventative measures include pre-natal visits. These visits can determine the size and position of the baby. This allows for an alternate plan (such as a C-section) to be suggested, avoiding a difficult and risky delivery.

The following delivery and pregnancy situations may contribute to Erb’s palsy:

  • Use of vacuum extraction tools or forceps during delivery
  • Infants with high birth weights
  • Mothers of small stature
  • Mothers who have gained excessive weight during pregnancy
  • Breech births
  • Labors where the second stage lasts for longer than an hour
  • Birth injury from excessive pulling of shoulders during delivery

Erb’s Palsy Treatment Options

A baby with Erb’s palsy can actually benefit from a highly diverse team of specialists. Physical therapists, neurosurgeons, neurologists, occupational therapists, and orthopedic surgeons all understand how the nerves of the brachial plexus work. Each each may have a different view of the condition. Having them consult with one another can lead to the most comprehensive treatment plan.

If this is not possible, then a pediatric neurologist is the most qualified physician to identify your best path forward.

Surgical Treatments

A baby may need to undergo surgery for the more serious types of Erb’s palsy. The procedure should be done before the child reaches six months. It will be most effective when they are young, especially if the child needs microsurgery. This is done under a microscope on children around three months of age.

If the child has a rupture of avulsion, he or she may regain partial function from a surgery performed at six months. If the child has had scar tissue from a neuroma, there is exploratory and grafting surgery. It may be able to repair the nerve and alleviate the weight of the tissue. Grafting has been known to restore a significant amount of functionality, though the actual improvement will be depending on the individual child.

Non-Surgical Treatments

Physical therapy and massage therapy can help improve the strength of the arm and the nerves. This is usually true in more mild cases and will include both home care and professional care. Parents should know exactly what’s being done in these sessions. Routines should help rather than interfere with the child’s progress. Some babies may actually benefit from Botox. It can send stimulation to the child’s arm that helps the nerves recover. Botox treatments are typically done for up to two months. If there is no improvement,  it may be time to consider surgery.

Overall Long-term Effects of Erb’s Palsy

The good news is that up to four in five cases of Erb’s palsy will be entirely cleared up within a year, so long as consistent treatment and care are given to the child. Mild cases may need only a few months of treatment. This means that there will be no delay in the child’s development. The sooner treatment starts, the more likely it is to disappear without a trace — this is true of both surgical and non-surgical treatments.

Parents should pay attention to how well a child can make fists or grasp (even reflexively onto fingers or toys) from as early as the day they’re born.

If a child has a more severe case, they may end up with major loss of function in their arm for the rest of their life. Erb’s palsy can cause contractions of the arm similar to those of cerebral palsy. It can also be extremely frustrating for a child to deal with, where normal tasks and movements are a real struggle. It will limit the types of activities that they can become involved with, which can be detrimental to a child’s sense of self.

The more attention and care a parent shows during every stage of the disease, the more likely it is that the child will be able to weather what’s ahead. Children and adults without full use of their arms can certainly lead fulfilling lives, with just a few adjustments and sacrifices.

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