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Erb’s palsy, also known as brachial plexus palsy, is a condition that can occur in newborns or adults due to injury to one or more nerves in the arm. It can result in paralysis or limited movement in one arm and can cause lifelong effects if left untreated. Early intervention is key to restoring full arm function. Treatment may include surgery or nerve grafting. Avulsion, when the nerve is completely torn from the spinal cord, is a rare but serious complication.
Erb’s palsy is a condition that most often occurs in newborns due to injury during delivery. British physician William Smellie first noted the condition in 1768, although he derives its name from the writings of Wilhelm Heinrich Erb, a 19th and early 20th century neurologist.
You may also hear Erb’s palsy described as brachial plexus palsy, and while it’s more common in infants, it can occur in adults. Paralysis or limited movement occurs in one of the arms due to injury to one or more nerves that give us sensation and range of motion in our arms. There are five nerves that can be affected, resulting in a slight to major reduction in sensation or movement in one arm. All five nerves that can be damaged and create the condition are part of the brachial plexus, a network of nerves that are attached to the spine from the neck to the middle of the upper spine. If these nerves are injured in adults, the same symptoms can emerge.
Usually Erb’s palsy will result in babies due to dystocia, difficult presentation, and delivery. A child who is stuck in the first (vertex) head position may have nerve damage from pulling on the shoulders. Breech birth can also cause the condition, if the arms are raised above the head and extended. Some cases occur if the newborn’s collarbone is broken.
Although some children can recover from Erb’s palsy, others can have lifelong effects if left untreated during the first year of life. Treatment may include taking nerves from the opposite leg and grafting them to affected nerves in the arm to improve range of motion and sensation. Other surgeries may be chosen instead, depending on the degree of damage and the nerves affected.
Left untreated, Erb’s palsy can cause the arm to stop growing, have limited range of motion, or a complete inability to move the arm. Some people also develop arthritis early on in the affected arm and shoulder, and those who have had treatment are also more likely to develop arthritis. When surgery is even partially successful, patients usually need physical therapy to help regain range of motion.
Very mild cases of Erb’s palsy, in which a nerve was minimally stretched during delivery, can recover completely without intervention. However, the key to restoring full arm function is early intervention. If you notice that a child’s arm rarely, if ever, moves or seems weak compared to the other arm, you should talk to your child’s doctor and ask for a referral to a specialist experienced in treating children with this condition.
In very rare cases, avulsion occurs, when the nerve is not only stretched or damaged, but has been completely torn from the spinal cord. Ideally, this should receive treatment as soon as possible, although treatment may not be able to fully restore function. However, it may give children a better chance of regaining some function in the affected arm.
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