Erb's Palsy

Erb’s palsy refers to a muscle weakness in the arms or the shoulder, occurring as the after-effect of an injury to the brachial plexus at birth. It is a nerve condition that results in loss of muscle function since it impacts the brachial plexus of nerves, which controls the muscles and sensation of arm and hand.

Common signs and symptoms of Erb’s palsy:

• Paralysis or decreased movement of the shoulder, arm, elbow, and/or hand
• Tingling sensation in the arm or hand
• A usual hand position - where your palm points toward the back with the fingers curling
• Limited feeling or sensation in the affected arm

The injury may also cause other problems in babies, such as:

• Horner's syndrome, where the eyelid droops 
• Breaking of the collarbone or clavicle

Causes of Erb’s Palsy in Infants

It may happen when the baby’s shoulder gets trapped in the mother’s pelvis during childbirth. It can also happen because of the baby's position inside the uterus.

Types of Erb’s palsy injuries:

The injuries are classified into 4 types. Treatment decisions are mostly based on the severity of the injury to the nerves.

• Neuropraxia: In this type, there is a stretch injury that causes a shock but does not tear the nerve. Such injuries usually recover fully or partially on their own within 3 months.
• Neuroma: It is a stretch injury where there is damage to some of the nerve fibers. It may even lead to scar tissue. In such cases, there is usually partial recovery instead of complete recovery.
• Rupture: In this case, the nerve is torn apart. Such ruptured nerves do not heal on their own. The rupture can be repaired by joining it together with a nerve graft taken from another part of the child’s body.
• Avulsions: It is the most severe type, where the nerve is torn from the spinal cord. Unlike ruptures, it is not possible to repair an avulsion. However, it may be possible to restore some of the arm’s function by replacing the detached nerve with a nerve from another donor muscle.

Treatment at Maruti Clinic for Children Orthopaedics

We provide treatment for Erb’s palsy based on the severity of the injury. There are some cases of injuries that resolve without treatment within three to four months. 

Our treatment process starts with a physical examination. Usually, very little or no investigations are needed in a newborn. Sometimes, we may suggest imaging tests like a nerve conduction study, an X-ray to identify any broken bones or an MRI. For older patients, sometimes EMG is required to assess the muscles of the upper limb.

For mild cases of stretched nerves, we suggest exercises and physical therapy for your baby, which the mother has to do at home. The stretching exercises and range-of-motion help prevent stiffness in your baby's arm, hand, and wrist. It helps prevent a joint contracture, which, if left untreated, can cause worrisome sequelae, such as joint dislocation. We will guide you on the number of times to do the movements each day. We may incorporate hydrotherapy into your baby’s physical therapy plan to minimize stress on your baby’s body.

Sometimes, we may administer a Botox injection to paralyze the working muscles so that the weaker muscles will take over. We may splint your baby’s hand to prevent it from rigidity and curling inward.

For severe cases of torn or damaged nerves, if there is no improvement when the baby is 6 months old, we may recommend surgery:

• Nerve repair: It consists of nerve grafts, nerve transfers, nerve decompression, and neurolysis

For other children who are brought to our clinic when they are a few months or years old:

These children will need a diligent clinical examination to look for weak and working muscles, any joint contractures or stiffness, any bony deformity, etc. Subsequently, these children also may need one of the following treatment options-

• Physical therapy: We recommend exercises that can help the children gain mobility and strength
• Tendon transfer surgeries: We transfer another working muscle/tendon to work in lieu of the damaged muscle.
• Osteotomy: Sometimes, children may also need bony surgeries (osteotomy)

Ideally, treatment for a baby with Erb’s Palsy is more effective when started early in the neonatal period.

We focus our treatment on helping your child regain strength and mobility in the affected arm.