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Erbs Palsy

Erbs palsy is a medical condition characterized by weakness and loss of motion in the arm. Erbs palsy is a birth injury to the brachial plexus, specifically the upper brachial plexus at birth. Erb’s palsy is known as shoulder dystocia or brachial plexus palsy since the brachial plexus nerves in the shoulder have been abnormally injured, damaged during difficult delivery.  The brachial plexus is network of nerves that extend from the spine, through the neck and armpit area, and down the arm.

Causes

The main reason for Erbs palsy is dystocia, an abnormal or difficult childbirth or labor. In this case, infant’s neck is stretched to the side during a difficult delivery. It mainly happened when the infant’s head and neck are withdrawn toward the side with simultaneous pass of the shoulders through the birth canal.

A similar condition may be also seen at any age after trauma or injury to the head and shoulder, if nerves of the plexus are violently stretched.

Symptoms

  • Inability to move arm or shoulder
  • Arm bent toward body
  • Weak or absent reflexes in the affected arm
  • Loss of feeling in the affected arm
  • In some cases, pain in the affected arm
  • Decreased ability to grip in the affected arm
  • Waiter’s tip posture

Treatment

Some children with Erbs palsy heal without treatment. In fact, many of them usually show improvement after three or four months of birth, however it may take one or two years to recover. Most of children with Erbs palsy will have normal arm, and shoulder functions. The main treatment for Erbs palsy is physical therapy. Surgery may be the last option in some severe cases.

Physical Therapy Interventions

Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis, and the goals of the patient or client.

In the first 6 months, the main goal of treatment is prevention of fixed deformity. The daily administration of exercise therapy is highly recommended to maintain range of motion (ROM), and improve muscle strength and performance. The parent role is to actively maintaining ROM and monitoring the right muscle fit. Exercises should include bimanual or bilateral motor planning activities. Sensory stimulation is also advised as an effective way to increase awareness of the arm. Electrical stimulation, and constraint induced movement therapy could be also beneficial.

Medical Interventions

The three most common treatments for Erb’s Palsy are: Nerve transplants, Sub Scapularis releases and Latissimus Dorsi Tendon Transfers.

Nerve transplant

From the opposite arm or limb, may be performed on babies under 9 month age. It cannot be made over the age of 9 months since it may carry risks other than benefits.

Subscapularis release

Can be performed at any age. It is a “Z” shape into the subscapularis muscle to enhance the stretch within the arm. Integrity of muscles can be negative affected, if subscapularis releases are performed repeatedly on the same arm.

Latissimus Dorsi Tendon Transfer

Is performed by cutting the Latissimus Dorsi in half horizontally to withdraw part of the muscle around and link it to the outside of the biceps. Parts of the biceps may be highly sensitized as a consequence of this operation.

Prognosis

It is dependent on both the severity of injury, and beginning of treatment. In fact, the earlier the treatment starts, the better the results. With physical therapy interventions, majority of mild cases may completely relieve in the first year or life. Good prognosis is seen with effective hand grasp during treatment.

If Erb’s palsy lefts untreated, it may lead to:

  • Full or partial paralysis could be seen in the affected arm
  • Constant and permanent arm weakness and numbness
  • Muscle atrophy (a decrease in the mass of the muscle)