Erb’s Palsy

Erb’s Palsy commonly refers to nerve injuries involving the nerves leading from cervical vertebrae #5 or #6 (C5-6).

These nerves are part of the “brachial plexus.”

The brachial plexus refers to the constellation of five nerve groups which proceed from the spinal cord in the neck to the shoulders, arms, wrists and fingers.

The stretching or tearing of the nerves in the brachial plexus can cause the partial or total paralysis of the muscles in either the left or right shoulder, arm, or hand.

Erb’s Palsy involves nerve injuries which typically affect the muscles of the shoulder and upper arm.

Pediatric Erb’s Palsy injuries most typically occur during the delivery of the baby, when the physician, nurse midwife or nurse carelessly applies too much force to the baby’s head and neck during the process of delivery. Such pulling and twisting of the baby’s head and neck will stretch and sometimes tear the nerves in the brachial plexus, resulting in Erb’s Palsy.

An unsafe and careless medical practitioner may pull or twist the baby’s head and neck if the baby’s shoulder becomes “stuck” behind the mother’s pubic bone in the birth canal. This condition is typically known as a “shoulder dystocia.”

Although the medical community has developed maneuvers that will permit a baby to be safely delivered even if a shoulder dystocia occurs, many unsafe and careless practitioners do not understand or fail to properly apply these maneuvers, thereby directly causing an Erb’s Palsy injury.

Erb’s Palsy often results from the rupture or tearing of the nerve roots, sometimes called an avulsion. Severe Erb’s Palsy injuries involving severely stretched or avulsed nerves do not typically resolve, even with interventions such as physical therapy and stretching and range of motion exercises. Often, the definitive treatment for severe Erb’s Palsy injuries is surgery which may include nerve reconstruction surgery or muscle-tendon replacement surgery.

A permanent Erb’s Palsy injury will leave the child with a potentially deformed and paralyzed arm. Permanent Erb’s Palsy injuries are characteristically associated with weakness in the shoulder, and a corresponding inability to lift the arm above the head or to turn the hand over so that the palm faces up, a movement known as “supination.”

Children with permanent Erb’s Palsy injuries are also often unable to properly flex their elbows, compromising both strength and range of motion. This will often prevent the affected child from being able to move his or her hand to the mouth.

A permanent Erb’s Palsy injury can affect a child’s self-esteem, and severely limit his or her ability to perform daily tasks such as getting dressed, bathing, and tying shoes. Moreover, when the child becomes an adult, an Erb’s Palsy injury can restrict employment opportunities, especially in occupations requiring bimanual skills or the use of two strong, functioning arms.

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