Erb’s Obstetric Palsy

Erb’s Obstetric Palsy is a form of brachial plexus palsy is caused by damage to the C5 & C6 (and sometimes C7) nerves of the brachial plexus (which is located just above the clavicle). It can be caused by trauma to the nerve roots (stretch, rupture or avulsion) during delivery or a a clinical emergency where it is imperative that baby is helped out of the birth canal. Symptoms vary depending on the severity of the injury and the actual location.

Presentation: Some infants present with mild weakness or discomfort in the limbs, where others may have a loss of sensation or severe pain. Many infants will turn their arm inward, with a bent elbow, others hold it straight (with their hand slightly cupped).  Either may have difficulty moving the limb and some may also have reduced grip.

Treatment: In some cases, the problem will disappear on its own, but in severe cases, surgery maybe necessary. Others respond well to manual therapy, such as physiotherapy and osteopathy. Hydrotherapy can also be used to support the affected limb during therapeutic treatment. Recovery takes 1-12 months depending on the individual case and severity, but most average cases recover around month 3-4.

Occupational therapy may also be necessary with slightly older children to ensure that they can undertake day to day activity, such as eating and typing shoelaces.

Home management: Parents may be asked to undertake some activities to help baby’s recovery. These may consist of stretching, motion exercises, sensory stimulation and strengthening activities.

Recovery: In many cases (up to 80%), where an appropriate care team has been consulted, recovery is successful.

Surgical approaches: Where manual therapy alone is inadequate, surgical options may be considered. These often take the form of: Nerve Graft Repair or Nerve Decompression.

References:
El-Sayed AAF. Evidence of the Effectiveness of Primary Brachial Plexus Surgery in Infants With Obstetric Brachial Plexus Palsy–Revisited. Child Neurology Open. 2017;4:2329048X17709395. doi:10.1177/2329048X17709395. 
Al-Qattan MM, El-Sayed AAF. The outcome of primary brachial plexus reconstruction in extended Erb’s obstetric palsy when only one root is available for intraplexus neurotization. European Journal of Plastic Surgery. 2017;40(4):323-328. doi:10.1007/s00238-017-1302-2.
Al-Qattan MM, El-Sayed AAF. The outcome of primary brachial plexus reconstruction in extended Erb’s obstetric palsy when only one root is available for intraplexus neurotization. European Journal of Plastic Surgery. 2017;40(4):323-328. doi:10.1007/s00238-017-1302-2.