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Erb Palsy

(Erb-Duchenne Paralysis; Brachial Plexus Palsy)

Definition

Erb palsy is loss of motion and weakness in the arm of a newborn.

Vaginal Birth
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Causes

Erb palsy happens when a baby's neck is stretched during labor and delivery. This can result in damage to the upper nerves of the neck and shoulder. The nerve damage causes muscles in the baby’s arm to be weak.

Stretching may be caused by:

  • A long, difficult delivery
  • Delivery of a large baby
  • Shoulder dystocia —when the baby's shoulder gets caught above the mother's pubic bone during delivery
  • Breech delivery—a baby that is born bottom first instead of head first

Risk Factors

Things that may raise the risk of delivering a baby with Erb palsy are:

Symptoms

A baby may have:

  • Problems moving an arm or shoulder
  • An arm that is bent in toward the body
  • Poor reflexes in the arm

Diagnosis

Symptoms are often noticed after a baby is born. In others, the doctor may ask about the baby's symptoms and health history. A physical exam will be done.

Images may need to be taken. This can be done with:

Muscle and nerve activity may need to be tested. This can be done with:

Treatment

Most babies get better with time, though some weakness may remain. Physical therapy can help improve strength, flexibility, and range of motion.

Older children who are not helped by other methods may need surgery to improve function. Choices are:

  • Nerve graft or transfer
  • Releasing thickened tissue around the joints
  • Tendon transfer

Prevention

There are no known guidelines to prevent this health problem.

RESOURCES:

Family Doctor—American Academy of Family Physicians
http://familydoctor.org

Ortho Info—American Academy of Orthopedic Surgeons
http://orthoinfo.org

CANADIAN RESOURCES:

Canadian Orthopaedic Association
http://www.coa-aco.org

Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org

REFERENCES:

Abzug JM, Kozin SH. Evaluation and Management of Brachial Plexus Birth Palsy. Orthop Clin North Am. 2014 Apr;45(2):225-232.

Brachial plexopathy. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/brachial-plexus-birth-palsy. Accessed January 26, 2021.

Erb’s palsy. Patient UK website. Available at: http://patient.info/doctor/erbs-palsy-pro. Accessed January 26, 2021.

Erb's palsy (brachial plexus birth injury). Ortho Info—American Academy of Orthopedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00077. Accessed January 26, 2021.

Last reviewed December 2020 by EBSCO Medical Review Board Rimas Lukas, MD  Last Updated: 1/26/2021