One or two out of every 1,000 babies have Erb’s palsy, a form of brachial plexus palsy.
The brachial plexus is a network of nerves that merge together along the side of the neck. This system of nerves travels from the spinal cord to the clavicle and then spreads out into the arm; the brachial plexus nerves allow for movement and feeling in the arms, hand, and fingers, according to the American Academy of Orthopaedic Surgeons. The word “palsy” means weakness, so “brachial plexus palsy” refers to a weakness and loss of motion in the arm.
Erb’s palsy is one form of brachial plexus palsy that affects the upper nerves of the brachial plexus. Babies with Erb’s palsy may be able to move the fingers, but not the shoulder.
Babies with Erb’s palsy typically have weakness in one arm, loss of feeling in the arm, and total or partial paralysis of the arm. Parents and doctors can notice these symptoms when:
- The newborn is not moving the upper or lower arm or hand
- The Moro reflex is absent on one side
- The infant’s arm is bent at the elbow and held against his or her body
- The newborn has decreased grip on one side
Some children with Erb’s palsy have one arm that is noticeably smaller than the other because nerves have an effect on overall growth. (This size difference can become more pronounced as the child grows because the affected arm continues to grow at a slower pace than the other.)
Like other birth injuries, Erb’s palsy typically develops as a result of a difficult delivery. The nerves in the brachial plexus can be injured when:
- The infant’s head and neck are pulled toward the side as the shoulders pass through the birth canal
- The infant’s shoulders are pulled during a head-first delivery
- Pressure is applied to the baby’s raised arms during a feet-first delivery (also known as a breech delivery)
The risk of brachial plexus injuries increases when the newborn is larger than average or when doctors have difficulty delivering the baby’s shoulder after the head has already emerged—an event known as shoulder dystocia.
If a newborn shows signs of Erb’s palsy, a doctor should examine the collarbone for a fracture and get an X-ray if necessary. Mild cases of Erb’s palsy can often be resolved by gentle massages of the arm and range-of-motion exercises.
For more severe cases, surgery may be considered by the time the baby is a few months old. If the nerve root has separated from the spinal cord, known as avulsion, nerve grafts and nerve transfers might be considered.
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More than 11,000 babies are born every day in the U.S., and difficult childbirth or prenatal risk factors lead to birth injuries in 6-8 out of every 1,000 births. Other common birth injuries including swelling and bruising of the scalp, cephalohematomas, intracranial hemorrhage, subconjunctival hemorrhage, and facial paralysis.
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