You’re waiting patiently up to the moment of your sweet baby’s birth. You hope and pray she’s perfect. Your delivery is going smoothly, until baby has a little trouble in the birth canal. Your doctor needs to pull on her shoulder to get her all the way out, and everything seems fine once you hear her first little cry. They bring her over to nurse, and there she is: perfect. Then you start to notice a tiny thing — a little weakness in her arm.
Your sweet baby could have a brachial plexus injury. Erb’s palsy is one type of brachial plexus injury affecting the brachial plexus, which is the nerve network that controls how our arm moves and feels. Baby’s muscles in her shoulder, arm, or hand could be affected. The good news is, most babies with brachial plexus injuries will fully recover. Some may need therapies or surgery to improve their arm function, but many recover easily on their own.
This post will review the key things to know about Erb’s palsy, including its causes, symptoms, diagnosis, and treatment. If your baby’s Erb’s palsy was caused by a birth injury, we may be able to help.
What is Erb’s palsy?
First things first, defining Erb’s palsy. There are two main types of brachial plexus injuries: Erb’s palsy and Klumpke’s palsy. They are named after the doctors who discovered the injuries, according to the Brachial Plexus Center at St. Louis Children’s Hospital.
The first recorded mention of a brachial plexus injury was in the 1700s. In the late 19th century, Guillaume Duchenne defined the injury’s cause as a traction on the arm and shoulder during birth while Wilhelm Erb identified which nerves become damaged and how the muscles are affected.
Erb’s palsy involves disruption of the C5 and C6 nerve roots, resulting in weakness of the deltoid, biceps, coracobrachialis, and brachioradialis muscles. The C7 nerve root also is affected in about half of all Erb’s palsy cases. Erb’s palsy mostly affects the arm — or upper brachial plexus — which appears extended and internally rotated, with a flexed wrist and fingers extended. A rarer type of brachial plexus injury, Klumpke’s palsy, involves damage to the C8-T1 nerve roots, which affects the hand muscles and pupil of the eye on the affected side.
Erb’s palsy occurs in up to 2.6 per 1,000 live births. Clavicular fracture has been mistaken for a brachial plexus injury, though occasionally the two occur at the same time. In one review of over 11,000 deliveries, 11% of deliveries with clavicular fracture had Erb’s palsy, while 53% of deliveries with Erb’s palsy had a clavicular fracture.
See also: What is Horner’s Syndrome?
What causes Erb’s palsy?
Erb’s palsy can be caused by traction of the shoulder during delivery; when baby’s shoulder is stuck, that’s called shoulder dystocia. The brachial plexus can be stretched or injured when the shoulder is forcibly pressed downward to get baby out of the birth canal. This usually happens with larger babies, and Erb’s palsy is more common in breech delivery. However, Erb’s palsy can even happen during Cesarean section.
Weak shoulder and elbow movement remain a consistent problem in children with Erb’s palsy. They are born without movement of the affected arm but gain finger and wrist movement after a few weeks.
A total brachial plexus palsy results in a limp arm and is often associated with the nerve roots being detached from the spinal cord. Bilateral brachial plexus injuries are rare, but possible.
Erb’s Palsy Risk Factors
Risk factors for Erb’s palsy include:
- Fetal macrosomia
- Breech delivery
- Mom has several previous children
- Second stage of labor is prolonged
- Maternal obesity or diabetes
- Post-term pregnancy
- Midpelvic operative delivery
- Vacuum or forceps delivery
In one review of more than 14,000 births, 15 cases of brachial plexus injury, all Erb’s palsy, were present. All but one case involved vaginal deliveries, with birth trauma (shoulder dystocia) in eight cases, or about 53% of cases. No evidence of shoulder dystocia was found in the other seven cases. Seven out of eight babies in the shoulder dystocia group were large babies, while only one out of seven in the non-shoulder dystocia group were large.
Although the rate of C-sections has increased in the past 20-30 years, the incidences of brachial plexus injuries has remained unchanged.
See also: C-Sections: Everything You Need to Know
Diagnosis and Treatment for Erb’s Palsy
A brachial plexus injury is typically diagnosed soon after birth. At that point, treatment can begin. It may take up to six months to restore movement in baby’s arm. A neurologist or neurosurgeon will determine if a baby can recover completely from physical therapy or if she’ll need surgery. Electrical stimulation may be used to keep up muscle function, while gentle stretching may improve range of motion and prevent tightness in the arm.
In one study of over 300 infants born with brachial plexus injuries in the United Kingdom and the Republic of Ireland, about half of the children recovered fully after 6 months. Only 2% had no recovery. Most of these cases occurred due to birth trauma.
However, the rate of complete recovery from a brachial plexus injury after birth is generally 80% to 96%, particularly if baby shows signs of improvement within the first two weeks. Nearly 100% of babies will recover completely if they show signs of recovery in the first month after birth.
Contact an Erb’s Palsy Birth Injury Lawyer
If you and your baby experienced birth trauma during delivery and it led to a brachial plexus injury, you may be entitled to compensation. No one should have to suffer for someone else’s mistake. If your medical team was negligent while you were in labor or used forceps or vacuum delivery methods, contact Safe Birth Project today for a free consultation by filling out our online case evaluation form.