Erbs Palsy {Brachial Plexus}

Contents
i. What is Erbs Palsy?
ii. Distinct symptoms of Erbs Palsy.
iii. Causes of Erbs Palsy.
iv. Shoulder Dystocia
v. Complications of Erbs Palsy.
vi. Age of diagnosis.
vii. Treatments of Erbs Palsy.

What is Erbs Palsy?

Erb's Palsy also known as Brachial Plexus
Paralysis is a condition which mainly due to birth
trauma can affect 1 or the entire 5 primary nerves

that supply the movement and feeling to an arm.

Each baby's injury is individual. The paralysis can
be partial or complete; the damage to each nerve
can range from bruising to tearing. Some babies
recover on their own however some may require
specialist intervention. For many people this is a
life-long disability which can affect the mobility and
function of their arm, and impact upon their daily
life.

Distinct Symptoms of Erbs Palsy

Erbs Palsy is different than other forms of
palsy like athetoid cerebral palsy and is
characterized by weakness or paralysis of
the arm. The disorder causes varying

amounts of impairment. The levels of

impairment are known by some of the other
names for the condition. When the upper
arm is the only part of the limb affected, the
condition is simply called a brachial plexus
injury.
The condition is designated Erbs paralysis
when it affects moving the upper arm and
rotating the lower arm. If the condition
affects the hand it is
Called Klumpke paralysis; this form of the
condition can cause the eyelid to droop on
the side opposite to the affected hand.
Causes of Erbs Palsy
Erbs palsy is the result of a nerve injury. All
the arms nerves are connected to a group
of nerves near the neck which is called the
brachial plexus. The brachial plexus nerves
are responsible for feeling and motion in the
hand, fingers, and arm. Erbs palsy can be
caused by several things which can happen
during a difficult delivery.
Approximately one or two babies per
thousand births will have a brachial nerve
injury. The brachial nerves can be injured if
the babys neck and head are drawn to the
side when the shoulders exit the birth canal.

Pulling excessively on the shoulders as the

baby comes out head first can also lead to a
brachial nerve injury. During a breech birth
(feet first), the arms are usually raised and
may be injured from excess pressure.
Improved delivery techniques now prevent
many brachial plexus injuries. Larger than
average babies are at greater risk for this
form of injury; larger than average birth
weight is called macrosomia and is defined
as a birth weight of 8 lb, 13 oz or more. A
breech birth (the baby presenting
abnormallyfeet first) also puts the baby at
greater risk of injury.

 Shoulder Dystocia
Larger than average babies are especially at
risk for a problem during delivery called
shoulder dystocia. In shoulder dystocia, the
infants head is delivered normally, but one
shoulder becomes stuck under part of the
mothers pelvic bones. This is a difficult
situation for doctors to remedy. The
mothers position will be manipulated in an
attempt to free the babys shoulder and the
doctor will also manipulate the baby within
the birth canal. If manipulation and gentle
pressure fail, surgery may be needed.
Shoulder dystocia is dangerous to both the
mother and the baby. A delivery in which
shoulder dystocia occurs is most likely to
cause injury to the brachial plexus, resulting
in impaired movement of the injured arm.
Women who are short or who have had
gestational diabetes are at greater risk for
the occurrence of shoulder dystocia. So are
women with pelvic abnormalities. Prolonged
labor also increases the risk.
Sometimes shoulder dystocia occurs when it
anticipated that delivery will be normal. The
only thing physicians can do help prevent
injury in an unexpected situation is simply to
be always prepared for an emergency

during delivery and to have a medical team

familiar with difficult deliveries on hand
during even routine deliveries.
Use of forceps or a vacuum extractor should
be avoided if possible during delivery,
because use of these methods increases the
risk of shoulder dystocia. In the case of an
extra large baby or a delivery which is
expected to be breech, the physician should
advise the mother and her family of possible
problems and what may be needed to safely
deliver the baby.
Complications of Erb's Palsy
Most cases of Erbs palsy are due to
stretching of the nerve and will heal within
six to twelve months of delivery; stretching
shocks the nerve, but rarely leaves
permanent damage. Occasionally a stretch
injury will cause scar tissue to form around
healthy nerves; in this case recovery may
not be total.
Cases in which the nerves are torn are the
most serious and will not completely heal on
their own. In rare instances the nerve is
actually torn apart from the spinal cord; this
is called an avulsion. It is estimated that
fewer than 10% of brachial plexus birth

injuries result in permanent paralysis or

impairment.
Age of Diagnosis
Because Erbs palsy is caused by an injury
at birth, it is almost immediately apparent.
However, the extent of the injury may not
be known for some months after the babys
birth. Babies with Erbs palsy may lack a
Moro reflex on the affected side; the Moro
reflex, present in healthy newborns, occurs
when the infant is startled. A startled
newborn will throw out the arms to the side
with the palms up and the thumbs flexed. A
baby with Erbs palsy may hold the affected
arm tight against the body with the elbow
flexed. There may be little spontaneous
movement of the injured arm or hand. There
may also be a lack of strength in the infants
grip on the affected side. The affected arm
may develop more slowly than the healthy
arm and may be much smaller.
Treatments for Erb's Palsy
In cases of a simple stretch injury or mild
tear, Erbs palsy will heal on its own, but the
baby should receive physical therapy so that
the arm does not stiffen. Gentle massage
and range of motion therapy are used to

keep the muscles strong and the joint from

becoming contracted. More extensive nerve
damage may require surgery. If the nerves
cannot function properly, tendon transplants
are sometimes used.
Such options are generally not discussed
until the child is three to six months old.
Even with surgery, nerve injuries heal very
slowly and it may take two years or more for
a complete recovery. In some cases, the
affected arm will always be weak; the range
of motion may also be limited.