Erb’s palsy is damage to the shoulder nerves (called the brachial plexus nerves) and consists of a number of different symptoms depending on the severity of the damage. Some infants only have slight weakness or discomfort. Other infants have a complete loss of feeling in their arm while others experience intense pain. Most infants with Erb’s palsy have an arm turned inward toward the body and have difficulties in moving the affected arm. They may also have a weakened hand grip. Since the severity of the condition varies from patient to patient, some pediatricians might require surgery, while others prescribe physical therapy to treat the condition.
Hydrotherapy, often used as a form of physical therapy, can be used for infants with birth injuries such as Erb’s palsy and cerebral palsy because the anti-gravity environment takes the stress off of the musculoskeletal frame, allowing children with injuries to move less-painfully and to build up strength in the related muscle groups. In addition, hydrotherapy helps encourage normal movements in the affected arm while at the same time strengthening muscles and reducing spasms.
According to the American Cancer Society (ACS), hydrotherapy is an widely accepted form of treatment for all kinds of disorders, injuries, and illnesses, including cancer, sprains, broken bones, and more. Along with encouraging movement and creating an anti-gravity environment, hydrotherapy also relieves pain and stress placed on the affected area.
Some infants may take physical therapy, either alone or in combination with hydrotherapy to treat the condition. A physical therapist has a number of goals for your baby. Most recovery takes anywhere from 1 to 3 or 4 months, while other areas of recovery take longer. A full-flexation reduction for an arm, for example, could take up to 8 months, and a full shoulder rotation could take up to 12 months. Physical therapists are experienced in this field and know how long it generally takes for your child to learn and heal, often assigning exercises at home for you to guide through with your child. Physical therapy can be required for severe cases to accompany surgery, or for mild cases to work them through strengthening the area and healing on their own. Examples of physical therapy exercises may include:
- Gentle stretching exercises
- Sensory stimulation
- Range of motion exercises
- Strength exercises
In addition to exercises performed during physical therapy, parents are encouraged to continue these exercises at home. Furthermore, physical therapists will usually show parents the correct to hold their infant while in order to eliminate any additional problems to the affected area.
Occupational therapy usually comes after surgery and/or for those who sustained long-term damage. An occupational therapist works closely with a child affected by Erb’s palsy and helps them deal with everyday activities such as eating, tying shoes, playing, drawing, and more. In some cases, children with Erb’s palsy may need specialized equipment in order to help them carry out daily activities successfully.
Most doctors try to avoid surgery on such young patients, but in some instances, surgery is the only option, specifically in cases of severe Erb’s palsy. Sometimes pediatricians will recommend physical therapy for a period of time, and if the child shows little or no improvement, the pediatrician will then recommend surgery followed by additional physical therapy and in some cases, occupational. Examples of surgery for patients with Erb’s palsy include:
Nerve Graft Repairs
Nerve grafts repair is a procedure in which nerves from parts of a sensory nerve is taken from another part of the body to be used grafting material in order to repair the damaged nerve. Through the graft, once set in place, regenerating nerve fibers can then grow through the graft and connect with the muscles. As a result, patients have a chance in recovering their muscle functions in the affected arm once the nerve injuries repair. Studies suggests that patients who undergo nerve graft repairs have the best chances of success.
Nerve decompression surgery is considered a minimally invasive procedure in which a small incision is made into the skin, followed by the insertion of a specialized surgical instrument that decompresses the affected nerves. Once the affected nerves are decompressed, pressures from other parts of the body are eliminated, allowing the damaged nerves to repair.
It’s important to note that in severe cases of Erb’s palsy, your child may still experience issues with the affected arm, even after surgery. For example, your child may experience long-term arm weakness as well as long-term shoulder rotation difficulties. It’s recommended that a child continue with physical and occupational therapy after surgery for the best chances of recovery.
Other Factors to Consider
Some children with Erb’s palsy may grow up with the affected arm shorter than the other one, and it usually becomes more noticeable as the child grows. The best course of action is to help children learn to adapt by helping then understand their injury.
If your child continues to have exacerbating problems after treatment, other options may be available, including joint fusion surgery or a transfer of muscle and tendons in order to improve the arm’s functions.
Fortunately, most infants and children who undergo surgery will show significant improvement. According to the St. Louis Children’s Hospital and the Washington University School of Medicine, 81% of their patients who underwent surgery to repair the upper part of the brachial plexus were able to move their shoulder up greater than 90 degrees.
If You’re Still Pregnant
If you’re still pregnant or plan to become pregnant in the future, there are a few things you can do to help reduce the risks of your infant developing Erb’s palsy. Although it may not prevent medical negligence or malpractice, it will that you’re doing what you can to protect your infant:
- Be certain to get regular, prenatal checkups with a trusted physician. If you have any questions or concerns, be sure to ask your physician.
- Inform your physician if you’ve had any previous difficult births and if any previous children developed Erb’s palsy.
- Gestational diabetes has been linked to Erb’s palsy. Be sure to follow your physician’s instructions thoroughly if you’ve been diagnosed with gestational diabetes.