Erb’s Palsy
What is Erb’s Palsy?
Palsy is a medical term that refers to a weakness in or paralysis of muscles due to nerve damage. In Erb’s palsy, damage to brachial plexus nerves causes paralysis or weakness in the arm muscles. It most commonly occurs in babies as a result of birth injuries. Also known as a brachial plexus injury, older children or adults may develop Erb’s palsy after an accident or traumatic injury.
What Causes Erb’s Palsy?
The brachial plexus nerves run from the spine, down each side of the neck, and into each arm. These nerves control movement in the arms and relay sensations from the arms back to the brain. Damage to the nerves causes Erb’s palsy.[1]
Erb’s palsy is a fairly common birth injury in newborns. The nerves may become damaged from stretching along the neck during delivery. For instance, the baby’s head and neck may pull to the side as the shoulders emerge. During a breech delivery, the raised arms can stretch, causing damage.[2]
Risk factors for Erb’s palsy in a newborn include difficult labor, a long labor, an unusually large size, and a breech position.
Common causes of brachial plexus injuries in older children, teens, and adults are traumatic injuries from accidents: car or motorcycle accidents, falls, gunshots, or assaults. Sports injuries, especially in high-impact sports like football, can also cause Erb’s palsy.
What Are the Symptoms of Erb’s Palsy?
Symptoms of Erb’s palsy in an infant include no movement in the arm or hand, absence of reflexes in the affected arm, and the arm held straight and close to the body.[2]
In older children and adults, the symptoms include weakness or paralysis in the arm and decrease or loss of sensation in the arm. They may also experience a burning sensation down the arm’s length in minor injuries or severe pain in more serious injuries.
The severity of symptoms depends on the severity and permanence of nerve damage in the brachial plexus:[1]
- Avulsion. This is the most critical type of damage, a complete separation of the nerve from the spinal cord.
- Rupture. A rupture involves a tear in part of a nerve.
- Neuropraxia. The least severe injury is neuropraxia, stretching of the nerves.
- Neuroma. As the nerve heals, it may form scar tissue, called a neuroma. Scarring can cause ongoing symptoms.
How is Erb’s Palsy Treated?
Many infants born with Erb’s palsy will recover within a few months. Minor damage to the nerves heals without intervention, but physical therapy helps build muscle strength, prevent stiffness in joints, and speed the healing process.
More serious damage to brachial plexus nerves may require surgical interventions to restore feeling, movement, and muscle strength:[3]
- Neurolysis. This procedure removes scar tissue from healing nerves.
- Nerve graft. Surgeons remove nerve tissue from another part of the body to replace damaged portions of brachial plexus nerves. New nerve tissue hopefully grows over this bridge with time.
- Nerve transfer. For an avulsion, doctors may try a nerve transfer. They remove a nerve from another part of the body and connect it to the torn nerve and the spinal cord. The hope is that new nerve tissue will grow and restore some function.
- Muscle transfer. A muscle transfer involves moving a piece of muscle from the leg to the arm and attaching it to nerves and blood vessels.
What is the Prognosis?
Many cases of Erb’s palsy heal and result in no lasting damage. However, more severe injuries to the nerves can cause permanent disabilities or symptoms:
- Chronic pain
- Stiff joints
- Atrophied muscles
- Permanent weakness, limited mobility, or paralysis
Surgeries may restore some function and sensation, but the most severe cases of Erb’s palsy generally cause some degree of lasting disability.
Could My Baby’s Erb’s Palsy be Medical Malpractice?
Medical malpractice occurs when a physician, nurse, or other medical professional causes an injury through negligence. Brachial plexus damage during labor and delivery may or may not be negligent.
To prove negligence in medical care, you must show four things:
- A professional medical relationship between you and your baby and the doctor or nurse.
This is not difficult to establish. If you go to your doctor or a hospital to deliver your baby, the relationship is clear. - That the professional breached a standard of care.
Medical providers are expected to follow standards of care established by the majority of experts in the field. If your doctor or nurse did not follow it, they could be negligent. Another way to look at this is to compare what your provider did to what a similar professional would have done in the same situation. Was it the same or outside the norm? - That the breach in care caused an injury.
Maybe your doctor used an excessive amount of force on the baby during delivery or failed to perform a c-section leading to difficult labor. These actions or inactions may have caused Erb’s palsy. - That the injury resulted in damages.
If your baby’s injuries led to disability, pain, and ongoing medical bills, the injury caused damages.
What to Do if Your Baby Has Erb’s Palsy
If your baby shows any unusual or troubling symptoms, get an evaluation from a pediatrician as soon as possible. See a new doctor if you believe your current physician may be negligent. You need to make sure you and your baby get the best possible care going forward.
Document everything that happened, including your recollections of the delivery and those of anyone in the room with you. Keep your medical records, and your baby’s as well as any bills related to ongoing treatment.
Contact an Erb’s palsy lawyer, a lawyer specializing in personal injury, medical malpractice, and birth injuries. They can help you understand the situation, determine if malpractice likely occurred, and give you options for taking legal action to protect and provide for your baby.