Erb's Palsy (Brachial Plexus Injury)

Symptoms of Erb’s palsy can be seen soon after a baby is born:

• The newborn does not move their arm or hand.
• One arm is bent at the elbow and held against the body.
• The baby has a weaker hand grip with one hand.
• Certain reflexes are missing on the side with the brachial plexus palsy.

Erb’s palsy should not be confused with pseudoparalysis [SOO-doh-pah-RAHL-ih-sis]. In this condition, a newborn has an arm fracture and is not moving their arm due to pain, but there is no damage to the nerves.

When your baby is born, the doctor will do a physical examination, including testing your child’s hands and arms for signs of brachial plexus palsy. If your child is diagnosed with NBPP, they may need to be seen by a specialist if the condition doesn’t get better on its own.

If your child was not diagnosed at birth, but you notice that your newborn is not moving an arm, see your doctor.

Your child’s brachial plexus nerves may have been injured by being stretched too far. This can happen in a difficult delivery, with injury caused by:

• A breech delivery (buttocks first) that puts pressure on the baby’s raised arms
• A head-first delivery that stretches the baby’s shoulders
• A head-first delivery where the baby’s head and neck are pulled to the side as the shoulders are delivered through the birth canal

Brachial plexus injury does not happen only to infants. Adults can also suffer from brachial plexus nerve damage, caused by the neck being stretched too far, stress, pressure, or damage from cancer or radiation treatment.

Your doctor will do a physical examination on your baby right after birth to look for symptoms of Erb’s palsy. They will do tests such as:

• Looking to see if your child has trouble moving their hand or arm
• Watching for an arm that flops when the baby is rolled from side to side, or an arm held close to the body with the hand turned inward
• Testing your baby’s reflexes to see if they are the same on both sides of the body
• Examining your baby for a possible fractured collarbone, which may require an x-ray

Many babies will heal from the nerve damage and recover on their own within 3 to 9 months. Your doctor will show you how to gently massage your baby’s arm and do range-of-motion exercises on them.

If your baby doesn’t improve soon, they may have more severe nerve damage and need to see a specialist. Surgery might be an option if some strength does not return over time to the affected arm.

Children who don’t recover by 9 months old will not likely get sensation back in their arm. They may have a separation of the nerve root from the spinal cord. It is not clear whether surgery can help when the nerve problem is this severe. An expert may recommend a nerve graft or nerve transfer.

A few factors increase the risk of Erb’s palsy, such as an unusually large newborn, breech delivery, or difficulty delivering a baby’s shoulder after the head has emerged from the birth canal. Cesarean delivery is often done when a doctor is concerned about a difficult delivery. This can help reduce the risk of birth injuries, including Erb’s palsy, to an unborn baby.

• United Brachial Plexus Network

Erb’s palsy is named after Wilhelm Erb, one of the first doctors to describe the condition. (Palsy means weakness.)

The brachial plexus [BRAY-key-el PLEK-sis] is a bundle of nerves that attach to the spinal cord in the neck. As the nerves travel behind the collar bone, they branch and spread out into the shoulder and arm.

With Erb’s palsy, the brachial plexus nerves in your child’s neck have been injured. This nerve damage causes weakness and loss of motion in the arm (arm paralysis). In newborns, brachial plexus nerve damage can happen when the baby’s neck is overstretched during delivery.

This condition is also known as neonatal brachial plexus palsy (NBPP). It affects 1 or 2 out of every 1,000 babies.

There are different kinds of NBPP that are classified by how well your child can use their arm. Brachial plexus palsy usually only affects the upper arm. Another type of NBPP, Klumpke paralysis, affects the lower arm and hand, and is not common.