Causes of Erb’s Palsy

If you or someone you love has suffered with brachial plexus palsy, you are probably very familiar with both of these terms, the causes, effects, and failures. If you are not, then you need to be. If you’ve never had an encounter with Erb’s Palsy, as it is referred to, count your blessing, but be aware.

Erb’s is caused by an injury to the nerves that effect the neck and upper chest. These nerves supply feeling, control, and can cause pain to the shoulders and arms. Injuring any nerve can and usually does cause some kind of loss of control or pain and this one is no exception. Damaging the brachial plexus can lead to loss of feeling and/or movement in arms, hands, and fingers.

How often does this occur?
About 3 of every 1000 live births has an occurrence of Erb’s Palsy. About 25% of these occurrences suffer permanently. Erb’s Palsy is graded into forms depending on the degree of paralysis.

So how does this happen?
This injury can occur during childbirth. When a baby becomes lodged behind the mother’s pubic bone (shoulder dystocia), if the correct delivery techniques are not used, Erb’s Palsy, a possible permanent lifetime of impairment, can be the result.

Considerations for Erb’s Palsy

Before Delivery questions:
• Did you have risk factors like a small pelvis, diabetes, or a large baby?
• Did you ask if your baby would be at risk for shoulder dystocia?
• Did you ask or did anyone tell you about risk factors?

During Birth
• Was vaginal delivery difficult
• Were appropriate delivery techniques used
• Was there excessive pulling on the baby’s head or neck

Delivery Techniques – did a healthcare provider
• Help you pull your knees up to your chest or have you on your hands and knees?
• Apply pressure to your abdomen
• Did you have an episiotomy?

Warning Questions after Delivery
• Doctor tells you baby’s arm or collarbone had to be fractured
• You ask what’s wrong with your baby’s arm
• Will my baby have permanent injury?
• You ask how did this happen? Why?

Symptoms/Warning Signs of Erb’s Palsy
• Baby holds arm bent and in toward body
• Baby not moving hand, upper or lower arm
• Baby cannot grip or has a decreased grip on affected side
• The Moro reflex (startle reflex) – a startle reaction to a sudden loss of support (like when falling)

What should the Healthcare Provider have done?

Mom or baby may not have been cared for appropriately. If the healthcare provider failed in their responsibilities. How?
• Didn’t anticipate possible complications such as shoulder dystocia
• Didn’t use common preventive techniques in the presence of possible dystocia complications
• Pulled excessively on baby’s head or neck when shoulder dystocia was a known or anticipated complication