Erb’s palsy is an injury caused at birth that’s most common in a difficult labor and delivery. Infants develop the disorder when they have been unnaturally tugged on or pulled, resulting in the neck being stretched during the labor and delivery period.
Erb’s palsy is sometimes referred to as shoulder dystocia or brachial plexus palsy because the brachial plexus nerves in the shoulder have been abnormally shifted, damaged, or broken during delivery. The brachial plexus is group of nerve fibers that run from the spine, through the neck and armpit area, and down the arm.
It’s important for a physician to diagnose Erb’s palsy as quickly as possible so that treatment can begin and so that your baby can heal from the injury before it interferes with developmental growth or inhibits their lifestyle enough to become a disability.
Inability to Move Arm or Shoulder
One of the most common signs of Erb’s palsy is the inability to the move the affected arm and shoulder shortly after birth. While infants don’t have a lot of control or mobility, they do move their arms, even if just a little. If you suspect your infant is having problems moving an arm and/or shoulder, notify your doctor immediately.
Arm Bent Toward Body
Infants who suffer from Erb’s palsy may have the arm on the affected side bent toward the body. Since the brachial plexus nerves are damaged or broken, the baby needs to move the arm in a way that is the most comfortable.
If your child is positioning the arm in a way that looks abnormal or unnatural, there is a chance that the brachial plexus nerves have been damaged. In turn, the brachial plexus nerves cannot react as they normally would and therefore the arm may appear in an abnormal position. In most cases, the affected arm is limp and bent at the elbow towards the body.
Weak or Absent Reflexes
Since the brachial plexus nerves are responsible for sensation and reflexes in the arm, and because the brachial plexus nerves are broken or damaged, an infant’s arm will not respond as it should. To this end, the reflexes in the affected arm may be weak or absent. Reflexes are indicative of sensation and instinct, and the reflexes cannot perform properly if the nerves are damaged.
Loss of Feeling
Again, because the brachial plexus nerves are responsible for sensation, broken or damaged nerves mean no sensation. Infants with Erb’s palsy who lose feeling in the affected area generally do not react or appear to notice a squeeze or scratch, or anything an infant with an undamaged arm would normally react to.
Infants with Erb’s palsy have little sensation in the affected arm, sometimes resembling a foot that is asleep or, worse, no feeling at all.
In some instances, babies with Erb’s palsy may have abnormal sensations in affected area, such as irregular or intense pain. This is typically evident in the arm or shoulder itself, but pain sometimes occurs in the neck as well.
Pain is generally evident via high-pitched screams and cries when the affected area is touched, though if you’re adjusting to life with a newborn baby, you may not be able to identify the difference yet between a painful cry and a cry for food, or a tired cry. It’s important to consult with a physician right away if you suspect your baby is crying in pain.
An infant’s grip on the affected arm may be decreased significantly as a result to the injury on the affected arm. This can be identified rather quickly by placing objects in both hands and observing the grips in both hands. An infant with Erb’s palsy may have a light grip in the hand on the affected area or no grip at all.
Waiter’s Tip Posture
Since the affected arm hangs loosely and limp, bicep muscles can be damaged, and infants can take on what’s known as “waiter’s tip,” one of the most common physical symptoms of Erb’s palsy.
If left untreated, Erb’s palsy may lead to:
- Full or partial paralysis in the affected arm
- Permanent arm weakness and numbness
- Muscle atrophy (the wasting away of muscles)
Additional Factors to Consider
Erb’s palsy symptoms will range from mild to serious depending upon the severity of the injury. Additionally, symptoms will depend upon the site of the damaged nerves and which nerves were damaged. In mild cases in which the nerves were only stretched, symptoms may go away naturally within a few weeks or sometimes, month.
With more severe cases of Erb’s palsy in which the nerves are severed, symptoms typically won’t disappear on their own. Serious cases of Erb’s palsy normally require treatments such as surgery and rehabilitation, and the symptoms most often last for several years.
It’s also important to note that while surgery is sometimes the only feasible option in many of the severe cases of Erb’s palsy, there is no guarantee that it will be successful. Your physician should able to provide with more details, including the benefits and risks of surgery.
For additional details on surgical procedures, refer to our article Erb’s Palsy Treatment.