Erb's Palsy / Brachial Plexus Injury

Obstetric care has improved vastly over the decades, such that health outcomes for mother and babies are exponentially better than they used to be. However, complications during labor and delivery can and do occur. One such complication, which may arise from provider negligence, is Erb’s Palsy.

The Brachial Plexus

The brachial plexus is a delicate, but large, network of nerves that serves the arm and shoulder. If these nerves sustain damage during a traumatic birth, negative consequences can occur. The American College of Orthopedic Surgeons estimates that Erb’s Palsy occurs in around in one or two babies in every 1,000 births.

In babies, an injury to this bundle of nerves occurs during the delivery process – specifically, when the shoulder experiences stretching as it goes through the birth canal. Shoulder dystocia is one of the most common occurrences leading to brachial plexus injury and occurs when the shoulders get stuck in the birth canal. Other possible causes of brachial plexus injury include:

  • An infant’s neck is pulled to the side, stretching the shoulder
  • Pulling or excessive force with birth assistive tools like vacuum assist or forceps
  • Breech delivery that puts pressure on a baby’s raised arms
Risk Factors for Brachial Plexus Injury

Several possible risk factors exist for brachial plexus damage:

  • A baby that is larger than average
  • A breech (feet first) delivery
  • Wide-set shoulders
Symptoms of Erb’s Palsy

The symptoms of Erb's Palsy may present immediately after birth or parents may notice it in the first days and weeks at home with their infant. The symptoms may vary in severity and duration based on the nature of the injury. In some cases, the symptoms resolve on their own without treatment, but in other cases the nerve damage is permanent. Neonates may experience:

  • Numbness or paralysis of the shoulder area, which may make the baby seem floppy
  • Limited mobility, which may not be apparent until months after birth
Brachial Plexus injuries have four main types:
  • Neuropraxia, or stretching, is the most minor form of injury. In this type of injury, children recover fully without treatment.
  • Neuroma occurs when a nerve tears and heals on its own, but still cannot send appropriate signals because of scar tissue. This form of injury often requires surgery.
  • A rupture is a serious form of the condition that occurs when one of the nerves separates from other parts of the neural network, requiring surgery.
  • An avulsion is the most catastrophic form of the injury and occurs when the nerve tears away from the spinal cord.

For children who experience more severe forms of brachial plexus injury, the only available treatment is surgical intervention. Without this, there can be no hope of a full recovery. However, in some minor cases of Erb’s Palsy, the condition will heal spontaneously without treatment.

What Causes Brachial Plexus Injury?

Brachial plexus injuries, such as Erb’s Palsy, may occur because a baby is too big for the birth canal. They may also happen when a mother spontaneously goes into early labor while the baby is still in a breech (feet first) position.

In other cases, however, Erb’s Palsy may occur as the direct result of medical negligence. For example, using assistive tools during the labor and delivery process is sometimes necessary to assure the healthy delivery of the baby. However, using these tools with excessive force can lead to nerve damage and may be indicative of negligence.

Brachial palsy injuries such as Erb’s Palsy can be severe and lead to a lifetime of paralysis of the shoulder. For those babies affected by severe forms of the condition, timely surgery is the best option for restoring nerve function.