Erb’s palsy: what it is and how to bring a claim

Posted: 27/07/2022

This is the fifth article in our birth injury series, which follows our article on shoulder dystocia.

In this article we will be looking at Erb’s palsy: its symptoms, causes, treatment, and how our specialist team can assist you in bringing a claim if your child has been affected by this.

What is Erb’s palsy?

Erb’s palsy (also known as brachial plexus palsy) is a type of brachial plexus injury which causes weakness or paralysis of the muscles in the arm. The brachial plexus is a bundle of five large nerves that run from the vertebrae in the neck, under the collarbone and down through the arms, allowing movement and sensation in the arms. Erb’s palsy affects 1-2 of every 1,000 babies born, though it can in some circumstances be caused by an injury suffered later in life.

What are the main symptoms?

The characteristic signs and symptoms of Erb’s palsy are the following:

• Lack of reflexes on the affected side.
• Lack of movement in the affected arm.
• Decreased grip strength in the affected hand.
• An arm bent at the elbow and held tightly to the side of the baby.
• Hand held in a ‘waiter’s tip’ – ie turning backwards.

How is it caused?

Erb’s palsy can be caused by pulling on a baby’s shoulders, pressure on the arms in a breech position, or pulling to the side of the baby’s head as it comes out of the birth canal. Risk factors include:

• An unusually large baby.
• The breech position.
• Shoulder dystocia – when a baby’s shoulder is caught behind the mother’s pubic bone during childbirth (see our article on shoulder dystocia).
• Labour occurring for a prolonged period of time.

Factors affecting the severity of the injury suffered are:

• Number of affected nerves – if all nerves are affected, weakness/paralysis can affect the whole arm and hand.
• How badly the nerve(s) are damaged – if the nerves are only stretched, a quick recovery of the muscles is possible. However, a nerve which is completely pulled apart cannot repair itself and will lead to muscle paralysis.

What treatment is available?

Recovery usually occurs within 6 to 12 months for most babies born with Erb’s palsy. The recovery of damaged nerves takes time, but is possible. Early intervention is crucial for assessing the extent of the injury and then referring for appropriate management. Tests such as Electromyography (EMG) or imaging can confirm which nerves are damaged. Following diagnosis, most babies will require physical therapy to allow motion and prevent permanent stiffness in the arm while the nerves repair. Surgical intervention may be required in severe cases to reconstruct the damaged nerves using a nerve graft. For some babies, recovery is not possible, and they will have a life long disability affecting movement and function of the arm.

Timely treatment within the first 6 to 12 months can have a significant impact on recovery. If diagnosis or appropriate treatment is delayed, recovery is less likely.

How do I bring a claim?

Sometimes damage to the bracial plexus causing Erb’s palsy is unexpected and unavoidable. However, the following may be indications that the care received was negligent:

• Risk factors were not appropriately identified.
• Timely steps were not taken to manage shoulder dystocia.
• An earlier caesarean section was indicated but not offered.
• Incorrect tools were used, or tools were used inappropriately.
• In some circumstances, there was a failure to advise on risks relating to Erb’s palsy.

If your baby has suffered Erb’s palsy which you think may have been avoidable, you may be able to make a claim for compensation. Our specialist birth injury team are here to offer an informal discussion to let you know if we can help and what your options are. Please call us on 0800 328 9545, email clinnegspecialist@penningtonslaw.com or complete our online assessment form.

For further information, Birth Injury Center is a US-based birth injuries charity which provides information and resources specifically for those with Erb's palsy and their families.

Previous articles in this series:

• APGAR scores - what do they say about your baby's health?
• Bleeding after giving birth - what does it mean and when can it cause problems?
• Cerebral palsy: causes, common features and making a claim
• Shoulder dystocia: what is it, how is it caused, and what are the long-term effects?

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