Brachial Plexus Injuries and Erb’s Palsy Explained for Parents
Michael S. Porter
and Reviewed by
Eric C. Nordby
What is Erb's Palsy?
Erb's palsy, also known as Erb-Duchenne palsy or brachial plexus birth palsy, is a paralysis of the arm caused by injury to the upper group of nerves that control arm movement and sensation. These nerves, called the brachial plexus, run from the spine through the neck and into the arm.
The injury typically occurs during difficult childbirth when excessive force is applied to the baby's head and neck, stretching or tearing the delicate nerve bundle. This results in weakness or paralysis of the affected arm, though most infants recover with proper treatment.
While Erb's palsy can be frightening for parents, early diagnosis and intervention lead to excellent outcomes for the vast majority of children. Understanding the condition is the first step toward ensuring your child receives the best possible care.
Key Facts About Erb's Palsy
Nerve Injury Birth Condition
Erb's palsy results from damage to the brachial plexus nerves (C5-C6) during delivery, affecting the baby's ability to move and feel sensation in one arm.
Excellent Recovery Potential
Most children (80-90%) with Erb's palsy recover fully or nearly fully within the first year with appropriate physical therapy and early intervention.
Often Preventable
Many cases result from shoulder dystocia and improper delivery techniques. With proper management of risk factors and delivery complications, 70-90% of cases could be prevented.
Types & Severity of Brachial Plexus Injuries
The severity of Erb's palsy depends on which nerves are affected and the extent of the damage. Understanding your child's specific type helps guide treatment decisions.
Common Causes of Erb's Palsy
Erb's palsy is almost always caused by excessive force or improper technique during delivery. Understanding the common causes helps identify when medical negligence may have occurred.
- Shoulder Dystocia: Baby's shoulder becomes stuck behind the mother's pubic bone during delivery
- Excessive Traction: Pulling too hard on baby's head or neck during difficult delivery
- Improper Forceps/Vacuum Use: Misuse of delivery instruments causing nerve damage
- Large Baby (Macrosomia): Birth weight over 8 lbs 13 oz increases risk, especially with gestational diabetes
- Delayed C-Section: Failure to perform timely cesarean delivery when shoulder dystocia is anticipated
- Breech Delivery: Baby positioned feet or buttocks first, increasing risk of nerve injury
could be prevented
Signs & Symptoms of Erb's Palsy
Erb's palsy symptoms are usually apparent immediately after birth or within the first few days. Early recognition allows for prompt treatment and better outcomes.
- Arm hangs limp at the side
- "Waiter's tip" hand position (arm extended, wrist turned in)
- Little or no arm movement on affected side
- Lack of Moro reflex (startle response) on one side
- Weak or absent grip on affected hand
- Numbness or loss of sensation in the arm
- Not reaching or grasping with one arm
- Favoring one arm during play and activities
- Asymmetric crawling pattern
- Difficulty lifting arm above shoulder level
- Arm appears shorter or thinner than the other
- Delayed motor milestones on affected side
- Weakness in shoulder muscles
- Cannot bend elbow or bring hand to mouth
- Limited rotation of the arm
- Difficulty with wrist and finger movements
- Poor coordination on affected side
- Muscle atrophy if untreated
- Complete paralysis of the arm
- No sensation in hand or arm
- Horner's syndrome (drooping eyelid, small pupil)
- Significant size difference between arms
- Chronic pain or discomfort
- Joint contractures if untreated
Treatment & Recovery for Erb's Palsy
Most children with Erb's palsy recover fully with early intervention. Treatment begins immediately after diagnosis and is tailored to the severity of the nerve injury. The first three to six months are critical for recovery.
Physical Therapy
Daily exercises to maintain range of motion, prevent joint stiffness, and strengthen muscles as nerves heal. Usually starts within the first week after birth.
Occupational Therapy
Focuses on hand function, grasp development, and adapting activities to maximize use of the affected arm in daily tasks.
Hydrotherapy
Water-based exercises that allow gentle movement with reduced gravity stress, promoting strength and range of motion in a supportive environment.
Nerve Grafting Surgery
For severe cases not showing improvement by 3-6 months, surgeons may repair torn nerves using grafts from other parts of the body.
Nerve Transfer Surgery
Less critical nerves are redirected to restore function to paralyzed muscles when nerve grafts aren't possible or effective.
Tendon Transfer Surgery
For older children with persistent weakness, tendons from stronger muscles can be repositioned to improve arm function and appearance.
Resources for New York Families
New York offers extensive programs and resources specifically designed to support children with Erb's palsy and brachial plexus injuries.
- Early Intervention Program: Free services for children under 3 with developmental delays
- Brachial Plexus Centers: Specialized clinics at major NY hospitals including NYU, Columbia, and HSS
- Medical Indemnity Fund: Financial support for children with neurological birth injuries
- United Brachial Plexus Network: Support groups and educational resources for families
- Special Education Services: IEPs and accommodations for children with physical disabilities
Help Secure Your Child's Future
Find out if your family may be eligible for financial resources to help cover your child's care - therapy, equipment, and more.
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