Can you imagine losing control of your hand or arm? You can’t feel your fingers and griping things. This is called brachial plexus palsy or Erb’s palsy.
Erb’s palsy is the common name for a group of rare neurological disorders. Erb’s palsy occurs when there is an injury to the small, protective nerve roots responsible for sending movement and sensory signals from the spinal cord to the brain called the brachial plexus. In this condition, there is partial paralysis of one or more limbs. The individual may also have recurrent spasms or even weakness in other parts of the body such as in the arms, legs, and facial muscles.
Erb’s palsy is the most prevalent form of brachial plexus palsy. It results from brachial plexus injuries, which may occur from a birth injury or trauma to the upper nerves, and cause muscle weakness or paralysis.
Approximately two children out of every 1,000 are born with Erb’s palsy. It is usually not a permanent condition, and up to 80 percent of patients recover.
What exactly is Erb’s palsy?
Erb’s palsy is a condition where the brachial plexus, which is a network of nerves supplying different muscles in the arm and hand, is damaged. This causes muscle weakness, numbness, tingling, or pain in the affected areas. These types of neurological disorders can affect one or both arms, and the symptoms can be mild or severe and vary from person to person.
The condition is caused by a brachial plexus injury. A newborn can develop Erb’s palsy after a birth injury from a difficult vaginal conception, or even during a caesarian section as the obstetrician sometimes has to adjust the baby’s head and shoulders to ease delivery.
Erb’s palsy can also happen when you have a brachial plexus injury, caused by an accident, such as a fall from a high place, or another injury to the neck or soft nerve area of your body. Erb’s palsy is classified as an incomplete nerve injury, meaning that the nerve still exists but has some degree of damage. The condition is also commonly called Erb Duchenne palsy.
Types of Erb’s palsy
Brachial plexus palsy can be categorized into four types. Doctors classify the specific form of the condition, depending on how much damage the Erb’s palsy brachial plexus has sustained.
Below are the different types of Erb’s palsy.
- Neuropraxia – Neuropraxia is the most common type of Erb’s palsy. The patient has no loss of strength in the arm or hand. The muscle weakness may be mild or moderate, but there is no loss of function or a paralytic effect on the arm or hand.
- Neuroma – These types of Erb’s palsy brachial plexus injuries are formed when a nerve is torn and then heals, leaving scar tissue behind. The scar tissue interferes with the nerve’s ability to conduct signals to muscles as the scarred tissue puts pressure on it.
- Rupture – A rupture is an injury to the brachial plexus. When a rupture happens, the brachial plexus nerve is torn, but not from the spine.
- Avulsions – An avulsion injury involves tearing away at least part of the brachial plexus nerve from the spinal cord. An avulsion is the most severe form of Erb’s palsy.
What are the risk factors for Erb’s palsy?
There are several risk factors that can lead to Erb’s palsy, including:
- Birth weight – Brachial plexus birth palsy is more common in babies who weigh less than 5.5 pounds (2.5 kg) at birth.
- Breech presentation – A baby in the breech position (bottom first) at delivery is more likely to develop brachial plexus birth palsy.
- Excessive maternal weight gain – A woman’s body has an upper limit on how much it can support. If she gains more weight than her body can support, her womb may become swollen and compressed, causing problems for both mother and baby.
- C-section – The risks of a newborn developing child’s birth injury conditions such as Erb’s palsy and cerebral palsy can be increased if an inexperienced practitioner performs a C-section rather than an experienced one who has been trained in perioperative management (the process used to help women recover from surgery).
- Gestational diabetes occurs when a woman has high blood sugar levels during pregnancy and is not controlled with diet or medication. This condition can increase the risk of having a baby with brachial plexus birth palsy.
- Maternal diabetes – Maternal diabetes is associated with an increased risk of birth injuries and defects such as spina bifida, cleft lip/palate, heart defects, urethral obstruction, and limb reduction defects (malformations).
- Small or abnormal maternal pelvis shape can cause obstetric brachial plexus palsy, shoulder dystocia, and other birth injuries.
A woman’s pelvis and birth canal should be large enough to allow room for the baby’s head, neck, and shoulders to fit through fully and securely without any pressure being applied to the infant’s neck, back, or bottom. The birth canal also needs to have enough space both side-to-side and front-to-back so that the baby’s movements are unhindered by any restrictions in its movement.
- Use of forceps during delivery – The united brachial plexus network advises against using forceps and similar tools to deliver a baby, as they can cause obstetric brachial plexus lesions, and damage the baby’s brachial plexus.
- Use of vacuum during delivery – You may also want to consider surgery if physical therapy doesn’t seem to be helping or if there are complications from your condition that aren’t improving with treatment. Just like forceps, a vacuum is also sometimes used to help deliver a baby. If it’s used incorrectly, it can damage the baby’s brachial plexus nerves.
- Abnormal positioning of the baby during delivery – If the infant’s shoulder is caught on the mother’s pubic bone during delivery, it can cause nerve damage in the brachial plexus.
- Large baby – A baby who is larger than average can be more difficult to deliver and may be more likely to sustain damage to the brachial plexus.
- Prolonged labor – If labor lasts more than 18 hours, the baby may develop shoulder dystocia which can sustain damage to the brachial plexus.
- Use of Pitocin during labor – Pitocin is a medication used to induce or speed up labor. It can increase the risk of Erb’s palsy.
- Trauma to the arm and elbow flexion areas, such as from a motor vehicle accident or sports injury that may result in a shoulder dislocation.
- Age over 60 – People aged over 60 are more likely to experience symptoms of Erb’s palsy.
- Other brachial plexus injuries caused by medical negligence – For example, if a woman receives steroid injections without proper professional medical advice during pregnancy, this could increase her chances of developing Erb’s palsy in later life.
How is Erb’s palsy diagnosed?
Erb’s palsy is usually diagnosed by a physical examination. The doctor will check for symptoms and signs of brachial plexus palsy, such as
- A weak grip that may be painful or have limited use of the hand
- Weakness in the arm and shoulder
- Pain in the shoulder, arm, or elbow that may be aggravated by movement or weight-bearing activities
The doctor or pediatrician may also order the following tests to check the neck and shoulder, and get Erb’s palsy diagnosed. :
Electromyogram (EMG)
The most common test to diagnose Erb’s Palsy is the EMG. A needle is inserted into the muscle to generate a signal that can be detected by electrodes placed on the skin surface. The EMG will help determine if there are nerve injuries and if there are, it can tell you what muscles are affected and where they are located.
X-ray
A plain film of the head is required to rule out any skull fractures or intracranial lesions that may be causing symptoms or signs. If there are no abnormalities on the plain film then an MRI is done to see if there are any soft tissue lesions including bone lesions. A bone scan can also be done if there are abnormal findings on MRI, but this is not always necessary because it has poor sensitivity in many cases of Erb’s palsy.
Imaging studies
An MRI is a reliable imaging study to diagnose conditions like Erb’s palsy and cerebral palsy. However, if a patient is unable to undergo an MRI, then a CT scan would suffice. A CT scan can provide an overview of the soft tissues surrounding the brain and spinal cord. In addition, it allows the healthcare provider to rule out other causes of nerve dysfunction (such as tumors) before proceeding with further testing.
Ultrasound
This test can help determine whether there is involvement of brachial plexus nerves on the arm side of the body as well as identify possible causes of weakness in different areas such as elbow flexors, wrist extensors, etc. It also allows your healthcare provider to determine whether there has been a change in tone or strength over time which helps with differential diagnoses such as stroke or TIA’s vs CVA.’
Nerve conduction study
Nerve conduction velocity (NCV) testing is a reliable way to determine whether or not there is damage to the brachial plexus. The NCV measures how quickly electrical impulses travel along nerve fibers in your body. A normal NCV indicates no nerve damage; however, a slowed NCV suggests that there may be nerve damage associated with Erb’s palsy.
How is Erb’s palsy treated?
The treatment of Erb’s palsy is based on the severity of the condition and the age of the patient. The milder forms of Erb’s palsy are treated with physical therapy to strengthen the affected arm and hand. More severe cases of Erb’s palsy may require surgery to repair damage to the brachial plexus.
If you have mild symptoms of Erb’s palsy, you may be able to manage them with physical therapy alone. However, if you have more severe symptoms, your doctor may recommend surgery to get Erb’s palsy treated.
Non-surgical treatments
The non-surgical treatments for brachial plexus are few, but they can be effective.
Physical therapy
This is the most common treatment for Erb’s palsy, and it is typically used to strengthen the affected limb. This can help reduce spasms, which may cause stiffness and pain in the brachial plexus or shoulder joint. It also helps improve strength and flexibility, which may help prevent the development of brachial plexus injuries as you age.
Working with an occupational therapy professional
You may need to have a specialist in occupational therapy work with you to learn a range of motion exercises and methods that will help you build up your shoulder strength. A physical therapist will also work with your doctor to develop an exercise program that is appropriate for your needs.
Your physical therapist may suggest the following activities for you or your child’s Erb’s palsy treatment:
- Walking (brisk walking, jogging, swimming)
- Swimming laps or pool exercises
- Using a stationary bicycle or treadmill
- Hiking on a treadmill or using a stationary bicycle to ride uphill
- Weight training (lifting weights) in a gym or with weights purchased at home
- Patients may also be taught how to use a special brace or splint to help them strengthen the muscles around their shoulder blades and improve range of motion.
Medication
This can help to reduce pain and improve function in patients with Erb’s palsy. For example, there are several non-steroidal anti-inflammatory drugs (NSAIDs) available that can relieve pain, stiffness, or inflammation in the upper nerves of the body.
Others include medications used to treat high blood pressure, diabetes, or cervical rib symptoms. It is important for patients to discuss all of their medical conditions with their healthcare provider before taking any medications.
Surgical procedures
You may also want to consider surgery if physical therapy doesn’t seem to be helping or if there are complications from your condition that aren’t improving with treatment. Nerve surgery involves removing or replacing damaged tissue from your shoulder by making small cuts in the muscle itself. It’s usually done using general anesthesia (a medication that puts patients asleep during surgery).
Nerve graft
This is the most common surgical treatment for Erb’s palsy. It involves removing one or more nerves from an unaffected part of the brachial plexus, such as the upper arm, and grafting them to the affected arm. The surgeon may also need to remove bone in order to make room for the new brachial plexus nerves.
Nerve transfers
Another approach is nerve transfer, where a surgeon transfers the function of a small group of healthy nerves to another part of the body or to another part of the same limb. This is often done when surgeons think that there may be too much damage to other parts of the arm muscle.
Recovery
After a successful operation, patients must be careful to follow their doctor’s instructions for complete recovery or they could experience complications like total paralysis or loss of sensation in their arms or legs.
Other Procedures
Other procedures in the treatments of Erb’s palsy include:
Release of joint contracture
This releases tightness in the joint, allowing normal movement to occur again; it may involve stretching the muscle groups around the joint or using an instrument called a warm-water bottle. Treatment may also involve splinting, casting, and physical therapy. The goal is to help the patient regain a full range of motion in their shoulder and affected arm.
Tendon transfer
If an individual has lost much of their range of motion (ROM), doctors may recommend tendon transfer surgery. In this procedure, surgeons cut through the rotator cuff and insert a tendon from another part of the body into this area. The transferred tendons then connect with functioning muscles that are symmetrical on both sides of the body, which helps restore muscle balance and movement.
How can I prevent Erb’s palsy (brachial plexus birth palsy)in my newborn?
If your baby has palsy brachial plexus birth, he will have leg or arm weakness. You may notice that he cannot raise or lower his arm muscles normally or hold objects with his hands. Erb’s palsy symptoms usually appear within 2-3 days of the birth injury, but they can last for up to 6 months before going away.
While most cases of Erb’s palsy are mild and don’t require treatment, it can be serious in some cases and may need surgery to treat its symptoms.
The good news is that there are ways you can help prevent Erb’s palsy from happening to your baby.
Advanced planning
The first thing you should do is to make sure that you and your unborn baby and healthy and that there are no problems that may cause complications, such as palsy brachial plexus birth or cerebral palsy. You can also ask your doctor to check if there are any allergies to medications or foods.
Maternal healthcare
You should take care of yourself as well. Make sure you eat healthy foods and get enough rest. Maintain a normal weight and don’t smoke during pregnancy and after giving birth. If possible, join a physical activity program such as yoga or pilates or take classes in martial arts or other sports activities that will help reduce stress levels in your body and keep it strong for the future challenges you might face together with your newborn child.
Conclusion: Exercise and early treatment are the keys to complete recovery
As an adult, the best way to reduce your risk of developing Erb’s palsy is to stay fit and healthy. Exercise helps keep your muscles strong, which means they’re less likely to become weakened over time. You can also take steps to lower the risk of brachial plexus injury during exercise by wearing appropriate safety gear, such as a helmet or elbow pads.
Erb’s palsy FAQs
What muscles are paralyzed in Erb’s palsy?
In Erb’s palsy, there is a paralysis of the muscles that control the upper trunk, in particular those of the shoulder, hand, and lower arm.
What can I expect if I have Erb’s palsy or if my child has Erb’s palsy?
The following are the possible symptoms of Erb’s palsy:
- Difficulty moving one or both arms, legs, and/or hands.
- Slower than normal movement of the affected muscles compared to the unaffected arm.
- Stiffness in the affected muscles.
- Weakness or paralysis of the affected muscles.
- Painful swelling of the affected muscle(s).
Is Erb’s palsy a disability?
No, it isn’t. Erb’s palsy doesn’t affect your ability to walk or talk or do other daily activities that you enjoy. You may experience some limitations, but these usually go away after about six months of recovery time following the brachial plexus injury.
When should I see my healthcare provider about Erb’s palsy?
If you have any of the following severe symptoms of Erb palsy, please see your healthcare provider right away:
- Sudden weakness or total paralysis in one side of your body (paralysis)
- Arm numbness or tingling in one side of your body (paresthesia)
- Severe pain or discomfort in one side of your body (burning, stinging, throbbing)
- Difficulty walking, climbing stairs, or getting up from a chair.
