Erb’s Palsy Prognosis

Erb’s palsy is one of several conditions caused by birth injuries to an infant’s brachial plexus – a system of nerves in the shoulder and upper arm. Erb’s palsy may include conditions known as Klumpke’s palsy and Global palsy, which each are defined by the nature and location of the injury. These conditions also fall under the umbrella of Obstetrical Brachial Plexus Injury, or OBPI as it is commonly referred.

Brachial plexus injuries are often the result of trauma to the shoulder or upper arm, especially during a long or difficult delivery. Erb’s palsy affects the upper half of the brachial plexus and usually causes weakness or paralysis of the arm on the affected side. The prognosis for Erb’s palsy depends on where the injury took place and how severe it is. In many cases, Erb’s palsy resolves on its own with little or no treatment. In other cases, however, if the nerves in the upper brachial plexus are severely damaged, the affected arm may suffer from permanent weakness or paralysis.

Research and literature on the prognosis of children with Erb’s palsy is inconsistent, but it is our hope that the following information will help the families of children affected by a brachial plexus birth injury find some answers to the most common questions.

Is Erb’s Palsy Permanent?

The answer to this question truly cannot be generalized as every child, injury, and prognosis is different. The fact is, some children with Erb’s palsy recover partially or fully with the help of physical therapy and other non-surgical treatment methods. Others with severe damage to the brachial plexus nerves may only find recovery via surgical intervention months or even years after the injury. Unfortunately, even surgical intervention is not a guarantee that the symptoms associated with Erb’s palsy will completely resolve.

In the majority of cases, birth injuries to the brachial nerves can be treated with physical therapy and, if necessary, with surgery. However, the brachial nerves take a long time to grow and recover from an injury, so many children find that they still have symptoms of Erb’s palsy – shoulder, arm, or hand weakness; size difference in the affected arm – years after the injury, or in some cases for the rest of their lives.

The only way to determine the permanence of your child’s Erb’s palsy symptoms is to continuously discuss your child’s health with his or her doctor, and initiate treatment as your child’s nerves continue to develop and possibly recover.

How is Erb’s Palsy Treated?

Doctors have various treatment options to help a child recover from Erb’s palsy or other brachial plexus injuries. The severity of the nerve damage is the principal factor that determines which form of treatment is needed. It is often best to get a referral to a specialist or multidisciplinary center to evaluate your child’s injuries and possible treatment options. Unfortunately, primary care doctors may overestimate the potential for recovery, which can lead to a delay in treatment, familial anxiety, and longer-term effects of the injury.

Treating Erb’s palsy, or any form of brachial plexus injury, is most successful when it is initiated shortly following birth. The BMJ Open (British Medical Journal) publication recommends nerve repair take place by three months of age. It further has noted that, unfortunately, around 12 percent of multidisciplinary referrals occur among children three years or older who have “long-standing functional impairment”.

Treatment methods for children with Erb’s palsy or bracial plexus injuries may include the following:

  • In cases where the child’s nerves are stretched, doctors will recommend physical therapy to help the injury to heal and restore function to the affected arm. Physical therapists have various options to choose from, including strength exercises, sensory stimulation, and range of motion exercises. Physical therapy is more effective when family members help a child to do exercises at home to complement the treatments given by a therapist.
  • Other treatments for most cases of Erb’s palsy where nerve damage is mild to moderate include Hydrotherapy and Occupational therapy.
  • In more severe cases, surgical intervention is required. It is commonly used in cases of severe nerve damage, especially those that involve split or torn nerves. Doctors may also recommend surgery in cases where a child’s therapy treatments aren’t progressing as well as expected. Typically, surgery treatments for Erb’s palsy include nerve grafts or nerve decompression.

Keep in mind that the time for a recovery from a brachial plexus injury can range from several weeks to up to a lifetime of hopeful progress, depending on the specific type of nerve injury.

Are There Any Long-Term Effects for Children With Erb’s Palsy?

In many cases, there are no residual effects of Erb’s palsy after a child has received treatment and the nerves in the brachial plexus have healed. In some children who have suffered from the condition may grow up with the affected arm being shorter or smaller than the unaffected one. Other long-term effects may include:

  • Lingering weakness in one arm
  • Difficulties with circular movements of the shoulder or elbow joints
  • Decreased range of motion in affected joints
  • Contractures of affected joints
  • Decreased (hypo) or increased (hyper) sensitivity
  • Decreased fine-motor skills
  • Pain or discomfort

What Happens if Erb’s Palsy is Not Treated?

Failure to diagnose or treat Erb’s palsy can have a negative impact on your child. This impact may vary depending on the nature and severity of the injury. Consider the following:

  • The National Institute of Neurological Disorders and Stroke (NINDS) suggests that most neuropraxia injuries (minor stretching or dislocation) spontaneously heal over time in 90-100 percent of cases.
  • NINDS suggests that Avulsion or rupture injuries (more serious injuries to the nerves) often have little or no potential for recovery without surgical intervention.

If a child is diagnosed with Erb’s palsy but doesn’t receive any type of treatment, he or she may suffer life-long consequences, including permanent weakness in the affected arm. In cases where the nerves have been split or torn, total paralysis of the arm and shoulder on the injured side will result unless surgery is performed quickly.

A special “thank you” to the United Brachial Plexus Network (UBPN) for their assistance in updating this information. For more information about UBPN, visit their website at www.ubpn.org.

Sources:

  1. http://orthoinfo.aaos.org/topic.cfm?topic=a00077
  2. http://www.ninds.nih.gov/disorders/brachial_plexus/brachial_plexus.htm
  3. http://bmjopen.bmj.com/content/7/1/e014141
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263264/