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Birth Injury and Erb's Palsy

Steve Wagner

Erb’s palsy or Erb-Duchenne palsy is paralysis of the arm due to damage to the brachial plexus, a group of nerves running from the neck to the armpit region. During a difficult birth, these nerves can be injured, causing what is called brachial plexus birth palsy. When the upper branches of the brachial plexus are injured, it results in Erb’s palsy. This is the more common brachial plexus birth palsy, and results in an inability to move the shoulder. As opposed to those with “global” or “total” brachial plexus birth palsy, in which both the upper and lower branches of the nerve cluster are damaged, those with Erb’s palsy usually retain movement of their hands and fingers. Erb’s palsy occurs in up to 3 births out of every 1,000.

Risk Factors and Treatment

As mentioned above, nerve damage causes Erb’s palsy. A number of factors may increase risk of this type of birth injury, one of which is shoulder dystocia. Shoulder dystocia is an obstructed birth, meaning that something physically gets in the way of a normal, vaginal birth. In the case of shoulder dystocia, the anterior (the first to present after the head) shoulder does not readily follow the head past the mother’s pubic bone, becoming stuck. Other risk factors include:

  • The use of forceps or vacuum extraction tools during delivery;
  • Infants in a breech position;
  • Large infant size or high birth weight;
  • Small maternal size or excessive maternal weight gain;
  • A long second stage of labor (lasting over an hour).

The injury to the infant and the seriousness of the paralysis is linked to the kind of damage done to the nerves in the brachial plexus. If the injury sustained is neurapraxia, basically a nerve stretching injury that results in a bruise-type injury, the infant may recover fully on its own without treatment. A neuroma is a stretching injury where damages to nerves cause scar tissue. In the case of a neuroma, the infant is likely to recover partially, but not fully, from the injury.

Ruptures and avulsions are the most serious injuries. A rupture happens when the nerve itself is torn. An avulsion occurs when a nerve is torn away from the spinal cord. These kinds of injuries require surgical treatment, probably to include a nerve graft or nerve transfer, and intensive daily therapy to minimize the long-term affect of the injury on the child.


In addition to paralysis or loss of feeling in the arm, a child with Erb’s palsy will not be able to turn the arm away from the body and will have limitations in their ability to lift the affected arm up into the air. Because damage to nerves does affect growth, there will be a more noticeable difference in the size of a child’s arms as he or she grows into an adult.

If your child is suffering, don’t wait any longer. Shoulder dystocia and the resulting problems caused by Erb’s Palsy will be life altering for your child, and the medical expenses can become overwhelming quickly. Call the shoulder dystocia and Erb’s palsy attorneys at Wagner Reese today, and we will investigate your case to see if your child’s birth injury could have been caused by negligence on the part of your attending physician. We offer a completely risk-free, no-cost consultation: (888) 204-8440.


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