Erb’s palsy also known as Erb-Duchenne paralysis is a nerve disorder affecting the shoulder and arm, causing weakness or loss of muscle function. The brachial plexus, a cluster of five nerves connecting the spine to the arm and hand, enables sensations and movements in the shoulder, arms, and hands. The disorder is known as brachial plexus palsy, with Erb’s palsy being the most common variety, and occurs when these brachial plexus nerves are stretched or torn. Erb’s palsy specifically involves the upper nerves of the plexus. Palsy, also known as muscle weakness or paralysis, is characterized by partial or complete loss of muscle function.
Erb’s palsy can result in four common types of brachial plexus injuries:
Avulsion: This is the most severe type of Erb’s palsy, where the nerve completely tears away from the spine.
Rupture: In this type of injury, the nerve is torn, but the tear does not occur at the spine.
Neuroma: After a nerve tear and healing, scar tissue forms, putting pressure on the injured nerve and disrupting its signal conduction to the muscles.
Neurapraxia: Among the types of brachial plexus injuries, neurapraxia is the most frequent one. It involves the stretching of the nerve without any tearing.
Erb’s palsy primarily impacts the shoulder, arm, and elbow, while the hand muscles generally remain unaffected. However, individuals may experience tingling or numbness in their hands.
The common signs and symptoms of Erb’s palsy include:
The diagnostic process typically initiates with a comprehensive physical examination. Additionally, at Zia Medical Center in Dubai may recommend the following tests:
EMG (electromyography): This test evaluates the functioning of muscles and nerves to assess their efficiency.
Imaging tests: These tests capture detailed images of the internal structures in your body. Our specialist at Zia Medical Center in Dubai will suggest an MRI or a CT scan combined with a myelogram. In certain cases, an X-ray might be ordered to investigate the possibility of any fractures.
Erb’s palsy can affect both newborns and adults, but the causes and circumstances may vary.
In newborns, Erb’s palsy can occur during a challenging vaginal childbirth or a cesarean section. Sometimes, during delivery, we would need to reposition the baby’s head to facilitate the passage of their shoulders. However, this maneuver can lead to nerve stretching or damage, including tears. This particular type of Erb’s palsy is often referred to as brachial plexus birth palsy, obstetric brachial plexus palsy, or brachial plexus birth injury.
On the other hand, Erb’s palsy can also develop in adults due to traumatic injuries. Such injuries may occur from accidents, falls, or direct trauma to the shoulder or arm region, leading to damage in the brachial plexus nerves. In these cases, Erb’s palsy is not related to childbirth but rather arises from external events that impact the nerves in the brachial plexus.
The treatment approach for Erb’s palsy depends on the severity of the injury, managing brachial plexus birth palsy in newborns involves close monitoring by doctors to assess nerve recovery since most infants tend to recover naturally. Nerves regenerate at a slow pace, and it may take up to two years for a full recovery.
Nonsurgical treatment is the primary approach for Erb’s palsy in babies. Daily physical therapy plays a crucial role in maintaining joint flexibility and keeping the muscles active. Parents play an active role in performing exercises with their babies, as infants cannot move the affected arm on their own. Our doctor or a physical therapist will guide parents on appropriate exercises to preserve the range of motion in the shoulder, elbow, wrist, and hand. By doing these exercises frequently throughout the day, the risk of joint contracture, a condition marked by permanent joint stiffness, can be prevented.
In cases where no improvement is observed within the initial three to six months, surgical intervention may be suggested by the doctor to enhance potential outcomes. Microsurgery, employing high-powered microscopes and specialized instruments, is a common surgical method for brachial plexus injuries. However, it is essential to note that nerve surgery may not fully restore normal function, especially in older infants.
Various surgical techniques may be considered, such as nerve grafting, where a donor nerve graft is spliced to repair a rupture, or nerve transfer, which involves using a nerve from another muscle as a donor to restore arm function. Due to the gradual nature of nerve recovery, it may take several months or even years for repaired nerves at the neck to reach the muscles in the lower arm and hand. After surgery, our doctor will provide rehabilitation exercises to be performed at home to improve the baby’s strength and range of motion.
Other surgical options include releasing joint contractures, which involves freeing up thickened soft tissues around the shoulder and elbow joints to allow for more movement. Additionally, tendon transfer surgery may be performed to enhance the ability to raise the arm. This procedure involves moving a functioning tendon from its normal attachment in the body and reattaching it in the shoulder area to improve arm mobility.
Reducing the risk of newborns developing Erb’s palsy involves addressing certain risk factors related to shoulder dystocia, which is associated with this condition. These factors include:
For adults, reducing the risk of Erb’s palsy (brachial plexus injuries) may involve taking precautionary measures, such as wearing protective equipment when engaging in contact sports or riding motorcycles. These safety measures can help minimize the chances of traumatic incidents leading to brachial plexus injuries.
What to expect if one has Erb’s Palsy?
Erb’s palsy can exhibit varying outcomes depending on the severity of the condition and the timely initiation of treatment. In some instances, Erb’s palsy cases resolve spontaneously, while others respond positively to early interventions, leading to the restoration of normal shoulder and arm movement.
However, individuals with Erb’s palsy who do not experience early recovery and do not undergo corrective surgery may encounter difficulties with normal arm and shoulder mobility in the later stages.
For those affected by Erb’s palsy and their families, there are supportive organizations available to provide assistance and guidance. Connecting with these support groups can be beneficial in gaining valuable insights and coping with the challenges associated with Erb’s palsy.
At Zia Medical Center in Dubai, we understand the complexities of Erb’s palsy and offer comprehensive treatment options to address this condition effectively. Our team of experienced specialists specializes in providing personalized care, including physical therapy, surgical interventions, and ongoing support for patients and their families. If you or your loved one is experiencing symptoms of Erb’s palsy, don’t hesitate to seek medical attention at Zia Medical Center in Dubai. Our dedicated team is committed to delivering the highest standard of care and helping patients achieve the best possible outcomes for their condition. Together, we can work towards improving the quality of life for individuals affected by Erb’s palsy and restoring their shoulder and arm function to its fullest potential.