​Erb's Palsy (Brachial Plexus Birth Injury)

Brachial plexus is a structure comprising of several nerves that send signals to upper limbs and control their functioning. These nerves root from the spinal cord at an area near the neck, and extend throughout the shoulders, arms and hands to regulate the movement, flexibility and sensation of these organs. Any damage incurred to these nerves is termed as brachial plexus injury. Many factors can cause this injury such as trauma, wounds, tumour, inflammation, radiation treatments and sports activities especially football, resulting in stretching, compression, or tearing of the nerves.

A type of brachial plexus injury has been found to occur in infants during birth when it gets difficult to get the baby out safely. During birthing, baby’s shoulders may get impacted in the pubic bone and brachial nerves get injured due to stretching. This is termed as brachial plexus birth palsy or obstetric brachial plexus palsy. Brachial plexus birth palsy is of two types. One of the types is Erb’s Palsy, where the upper brachial nerves get damaged resulting in loss of motion or paralysis of shoulder and elbow.

Erb’s palsy is usually the mild form of brachial plexus, in which only stretching of nerves controlling the shoulders occur. But, in some cases, severe damage to nerves may also occur.

Symptoms for Erb’s Palsy include:

  • Inability in lifting arm above the head

  • Inability in bringing objects to the mouth

  • Inability in moving fingers

  • Inability in feeling things in the arm, hand or fingers

  • Tingling or pain in the arm, hand or fingers

If you observe your child showing any of the above symptoms, you should consult a paediatric neurologist at the Mind and Brain Service Line at the Aga Khan University Hospital.

Your time with your doctor maybe limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.

The doctor will initiate the diagnosis with clinical examination to evaluate if muscles of your child are in proper motion and sensing ability or not. The diagnosis will then be followed by certain electro diagnostic techniques to examine the activity of muscles and nerves when an electric current is passed. Then most important of all are image testing procedures which include Magnetic resonance imaging (MRI), Computerized tomography (CT) myelography and Angiogram which provides with detailed images of affected portions of the nervous system.

Erb’s palsy usually heals by itself with the help of some physical therapy during first three to four months after birth. Our doctors will teach you different exercising methods in which you can let your baby take part. These would help in improving flexibility and proper functioning of muscles and joints.

If symptoms show even after three months, then surgery would be needed to treat the baby. This surgery should be performed before the baby gets one year old, otherwise serious complications might occur. The doctors might select any of the following surgeries for your child

  • Nerve transfer: Another nerve or a branch of another nerve whose function is not very important or acts as an extra nerve is selected, and connected to the affected nerve. Since the newly connected nerve root is still attached to the spinal cord, it will perform the function of the affected nerve. To select a nerve from amongst the functioning ones, one that is near to the affected area is chosen. Usually motor nerves are chosen to stimulate muscles and sensory nerves to revive sensation.

  • Nerve graft: A segment of a nerve performing any less important function is removed and replaced to the portion of target nerve that has been damaged. Numbness is felt in the body part from where a nerve segment has been removed, and a patch or scar may appear on the outside, but it gets recovered itself.

Please click here for some guidelines onwhat to do before your surgery

Your child may feel pain and difficulty in movement of the shoulder even after few months of surgery, but with proper physical therapy, as suggested by your doctor, will help regain flexibility.

Please click here for some guidelines on “what to do on after your surgery

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.

The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.