Overview

What is Erb’s palsy? It is a neurological disorder affecting the nerves and muscles of the neck, shoulder, and arms. It can affect both children and adults. It is named after Doctor Wilhelm Erb, who described this illness at first. As per the American Academy of Orthopedic Surgeons (AAOS), Erb’s palsy is reported in one in every thousand births.

Erb’s palsy will not be caused by any disease. It is a birth injury that happens during delivery when doctors or professionals fail to take proper care. If adequate precautions are not performed, medical malpractice or incompetence during the delivery process might cause nerve damage to your baby.

Erb’s palsy is a disorder that causes arm weakness and loss of motion. It is also called Erb-Duchenne paralysis or simply Erb’s paralysis and may also occur when the brachial plexus is injured. Brachial plexus palsy is when the brachial plexus nerves do not function properly due to stretching or rupture. The brachial plexus is a bundle of nerves, and it gives rise to all the nerves of the arm. These nerves are used to provide sensation and movements to fingers, hands, shoulders, and arms.

Types of Erb’s Palsy

Erb’s palsy is divided into four categories.

  1. Neuropraxia
  2. Avulsions
  3. Rupture
  4. Neuroma

Neuropraxia

What is neuropraxia? It is the most common type of Erb’s palsy, which happens when a nerve is stretched but not torn. It is a mild injury that will clear up on its own within three months. It can still cause burning discomfort, and your child may be in a lot of suffering throughout this time.

Neuroma

In neuroma, scar tissue may form due to a strain injury that destroys some nerve fibers. The nerve tears and recovers, but scar tissue presses on the wounded nerve, preventing it from sending signals. Physiotherapy and surgery are frequently used to aid rehabilitation.

Rupture

When certain nerves rip and cannot mend on their own, it is known as rupture. Rupture will not cure on its own, and it needs surgery for recovery.

Avulsions

Avulsions are the most severe type of nerve injury, occurring when a nerve is separated from the spinal cord. Avulsions can be repaired with surgery; however, the injured nerve cannot be permanently attached to the spinal cord. So full recovery is not possible in avulsions.

Erb’s Palsy Causes

Erb’s palsy develops when a baby is bigger than usual, making delivery more challenging. Erb’s palsy in adults can be induced by a fall or an accident that exerts a severe downward strain on the shoulder.

If there is difficulty during childbirth, the doctors try to pull the child quickly and use greater force to bring the infant out of the birth canal. The excessive pulling of the infant’s head and shoulders may cause Erb’s palsy when they do so. It occurs when the delivery is complicated and prolonged.

Erb’s palsy can also occur in a newborn baby by being positioned in the uterus throughout the pregnancy and once delivery starts. The shoulders might become stuck inside the mother’s pelvis after the baby’s head has been coming out. The head is tilted to the other side to liberate the shoulders, and the brachial plexus nerves are stretched as a result.

Another reason is when the physicians drag the legs and feet of the baby during the birth. It causes the arms to go above the head and put unnecessary stress on the shoulder joints. After birth, the condition can occur when medical personnel take the newborn from his arms rather than holding the baby’s back and neck.

During difficult childbirth, there are also chances for other birth injuries such as cerebral palsy, Klumpke’s palsy, and facial paralysis.

Risk Factors of Erb’s Palsy

Several factors can raise a child’s risk of acquiring Erb’s palsy. The common Erb’s palsy risk factors are as follows.

  • Cesarean section
  • Maternal obesity
  • Breech presentation
  • Shoulder dystocia
  • Large infant
  • Difficult vaginal childbirth
  • Stretching the arm with vigor
  • Diabetes in the mother
  • The shape of the maternal pelvis is small
  • Prolonged delivery
  • Headfirst delivery
  • Twin or multiple deliveries

Erb’s Palsy Signs and Symptoms

The sign and symptoms of Erb’s palsy may vary according to the severity of the condition. The common Erb’s palsy symptoms are as follows.

  • The affected arm has restricted motion.
  • Numbness in arm
  • Arm paralysis (partial or total)
  • Grip strength is weaker in the injured hand
  • The newborn’s upper or lower arm or hand is motionless
  • Because nerves affect overall growth, some children with Erb’s palsy have one arm that is visibly smaller than the other
  • Being unable to crawl
  • One arm is paralyzed

A-picture-depicting-erb's-palsy

Erb’s Palsy Diagnosis

To determine whether there is any injury to the bones and joints of the neck and shoulder, your doctor may prescribe an x-ray, ultrasound, or other imaging investigation.

X-ray

An experienced pediatrician is consulted to confirm the diagnosis. To determine the extent of injury to the bones and joints of the neck and shoulder, the doctor will order an X-ray or an MRI.

Electromyography (EMG)

An Electromyography test is used to determine how well muscles and nerves function. The electrical activity of a muscle in response to stimulation is measured using electromyography (EMG).

Nerve Conduction Studies

A nerve conduction test is used to determine whether the individual nerves send the signal from the spinal cord to the muscles.

Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT)

On rare occasions, magnetic resonance imaging (MRI) or computerized tomography (CT) may be required to rule out other probable sources of nerve pressure.

Treatment of Erb’s Palsy

Can Erb’s palsy be cured? Luckily the illness is curable, and most infants will be able to recover completely. As per a study undertaken by Dalhousie University and the IWK Health Centre in Nova Scotia, around 80% to 96% of infants with this condition will recover completely.

Erb’s palsy will cure completely if it improves during the first two weeks. Almost all injured babies recover during the first few months. Surgery may improve the outcome of the few infants who do not heal by three to five months. Even with therapy, surgery, and wellness treatment, severe injury may never recover entirely. Erb’s palsy treatment options in adults or children must begin as soon as possible to achieve the best results.

Management of Erb’s palsy can be done in a variety of ways. When nerve damage is minimal, it usually heals automatically within a few months. It doesn’t require any treatment. Depending on the severity of the damage, the doctor may recommend treatment for your kid. Erb’s palsy treatment options include non-surgical treatment & surgical treatment.

Non-Surgical Treatment

There is therapy for Erb’s palsy patients who have suffered significant nerve damage. It includes hydrotherapy, physical therapy, occupational therapy, and recreational therapy.

Hydrotherapy

Hydrotherapy helps in the recovery of normal movement in the injured arm. It reduces stress on the neonate’s musculoskeletal system, letting them move more freely while strengthening muscles and minimizing spasms.

Physical Therapy

One of the most prevalent Erb’s palsy therapy options is physical therapy. From the age of three weeks onwards, your healthcare provider will recommend that you practice exercises and physical therapy with your infant. Erb’s palsy physiotherapy treatment should be done daily to preserve a range of motion and strengthen muscles. Mild stretching can cause nerve stress, which is considered a minor injury that will heal on its own with physiotherapy management of Erb’s palsy. It includes

  • Stretching exercises
  • Range-of-motion
  • Sensory activities
  • Resistance exercises
  • Strengthening exercises

Physicians suggest Erb’s palsy exercises for adults and children to promote arm awareness. The above exercises help the babies improve muscle strength, reduce the risk of joint stiffness, and improve their quality of life. Physical therapy for children differs significantly from physiotherapy for adults with Erb’s palsy. To avoid further muscle damage or nerve harm, parents must be as gentle as possible.

Occupational Therapy

While physical therapy for Erb’s palsy focuses on improving a child’s ability to do certain movements, occupational therapy focuses on helping both the child and the parents perform daily activities such as feeding and changing their kid’s clothes without causing more injury. The Erb’s palsy occupational therapy treatment in newborns lasts for the first two weeks of their lives. In cases with Erb’s palsy that have not improved on their own after 2 to 4 months, occupational therapy is frequently used.

Recreational Therapy

Following the earliest stages of basic physical therapy, your kid should be encouraged to participate in regular leisure activities, including those that require arm and shoulder motions, as they get older. Climbing, crawling, tossing, finger painting, picking up and eating food, and swimming are just a few of the things that recreational therapists may assist your kid with.

Surgical Treatment

If no improvement is seen after 3 to 6 months, your doctor may recommend nerve surgery to improve the outcome. The goal of Erb’s palsy surgery is to either repair or relieve pressure on the nerves of the brachial plexus to heal naturally. The following are the surgical methods used.

Nerve Graft

A healthy sensory nerve is removed from another region of the body as grafting material to restore your child’s damaged nerves.

Nerve Transfer

A surgeon may be able to restore nerve function by transferring a nerve from another muscle.

Prevention of Erb’s Palsy

Is Erb’s palsy preventable? Erb’s palsy can be avoided if the doctor ensures that the baby’s anterior shoulder bone does not collide with the mother’s pubic bone.

The doctor must monitor the size of the baby. If they determine the infant is larger than a particular size, they must schedule a cesarean section.

The healthcare professionals are responsible for taking a test to determine the baby’s size, position, and health throughout the pregnancy. If there is no chance for normal delivery, they must do alternative ways to prevent Erb’s palsy.

Difference between Erb’s Palsy and Klumpke’s Palsy

Both Erb’s palsy and Klumpke’s palsy are birth injuries with some minor differences. Let’s go through it.

  • Erb’s palsy is caused by paralysis of the upper brachial plexus, while Klumpke’s palsy is caused by paralysis of the lower brachial plexus.
  • Weakness and lack of mobility in the upper arm and hand are signs and symptoms of Erb’s palsy, and weakness and lack of mobility in the lower arm and hand are signs and symptoms of Klumpke’s palsy.
  • Neuronal injury to the upper C5 and C6 nerves causes Erb’s palsy, whereas mechanical damage to the lower C8 and T1 nerves, which causes paralysis of the forearm and hand muscles, leads to Klumpke’s Palsy.
  • Erb’s Palsy can cause problems in a person’s upper arm, including the shoulder or upper biceps. Klumpke’s Palsy can cause issues in a person’s lower arm, including the wrist, hand, and fingers.

Conclusion

Doctors, nurses, and other delivery room personnel have been trained to deliver babies safely and without difficulties. Unfortunately, medical carelessness is to blame for many cases of Erb’s palsy that might have been avoided with proper treatment.

Patients should be aware that there is no limit to how long they can wait to have their nerves fixed. The nerve permanently loses its link to the muscle after 12-18 months. Providing your child with the correct treatment will improve motor function, increase brain signals, and reduce growth deformity.

For adults, occupational therapy is the beginning and finishing of all surgical or non-surgical Erb’s palsy treatments. Your occupational therapist will assist you in carrying out the daily activities or chores that have been affected by your nerve injury.

If your child’s Erb’s palsy could have been averted, you can file a lawsuit under medical malpractice. No need to worry about Erb’s palsy surgery cost or treatment expenses. Thankfully, there are financial aid alternatives available to assist your family in getting your child the treatment they require. Attorneys are ready to assist you in filing Erb’s palsy lawsuit so that you can be compensated for your child’s treatment.