Living with Erb's palsy or brachial plexus nerve injury

If your child has partial or complete paralysis in one arm after a difficult or traumatic birth, they may be suffering from Erb’s palsy, a condition that is commonly caused by negligent birth injury to their brachial plexus nerves.

What is the brachial plexus?

The brachial plexus is a network of five nerves, including four of the lower cervical nerves (C5, C6, C7 and C8)  and the first thoracic nerve (T1), which run down the spinal cord and emerge from between the vertebrae in the neck, passing under the collarbone and forming the major nerves of the arm at armpit level. The brachial plexus nerves conduct signals from the spinal cord to the muscles and skin of the chest, shoulder, arm and hand, giving movement and feeling to the arm.

What is Erb’s palsy?

Erb’s palsy is a condition in which the nerves which give movement or feeling to an arm are stretched, bruised or torn, causing weakness or paralysis in the arm. The severity and duration of the disability suffered by the injured baby can range from mild and short-term to lifelong and severe. Erb’s palsy is also known as brachial plexus nerve injury.

Are there different types of Erb’s palsy injuries?

There are different types of Erb’s palsy or brachial plexus injuries, but it is not always easy to categorise the injury into one or other of the types, which depend on the extent of the damage to the nerves.

Identification of the type of brachial plexus injury can help with treatment decisions and make it easier to predict how the child will be affected by their injury in future.

The main types of Erb’s palsy injuries include:

• Neuropraxia

This type of nerve injury occurs when a nerve is stretched but isn’t torn. These injuries have a better prognosis (long-term outlook) than other types of Erb’s palsy injury and often resolve in a few months without treatment.

• Neuroma

A neuroma is more serious stretching of the nerves which may partially improve with time but usually leaves scar tissue and some long-term damage.

• Rupture or tearing of the nerves

These serious injuries need treatment with nerve grafting surgery.

• Avulsion

‘Avulsion’ refers to any injury where tissue that is attached to a bone is completely torn away from it. In Erb’s palsy injuries, an avulsion injury means that the nerve has been completely torn from the spinal cord. Surgery may be possible using healthy nerves from another part of the body but this is a very serious form of brachial plexus nerve injury.

What causes Erb’s palsy?

Erb’s palsy is usually caused by excessive traction (pulling) on the baby’s head and shoulders during a vaginal delivery. The risk of Erb’s palsy increases where there is ‘cephalopelvic disproportion’, which means that the baby’s head is disproportionately large for the size of the mother’s pelvis, either because the pelvis is small or unusually shaped, or the baby is big or is incorrectly positioned for delivery.

Shoulder dystocia can occur when the baby’s head descends into the birth canal but delivery is obstructed because one or both shoulders become wedged behind the mother’s pubic bone. As the baby’s head is pushed down, the baby’s brachial plexus nerves are stretched. The baby appears stuck and requires very careful handling by the midwife or doctor to be delivered safely. Excessive pulling on the head during attempts to deliver the baby can cause damage to the brachial plexus nerves, resulting in Erb’s palsy.

Erb’s palsy can also be caused by pressure on the baby’s arms during a breech (feet first) delivery.

In childbirth, the risks of Erb’s palsy are also increased by:

• using extraction instruments during delivery (such as forceps);
• a lengthy second stage of labour (pushing stage);
• where the baby is large;
• maternal excessive weight gain.

Can Erb’s palsy be treated?

The milder form of Erb’s palsy may heal, in part or completely, by itself. For the best chance of recovery, it is essential that the injured baby undergoes tests as early as possible to find out which nerves have been damaged, so that any necessary treatment is started quickly. 

Treatment may involve:

• physiotherapy - to increase movement in the arms or shoulders and to improve grip strength in the hand;
• occupational therapy (OT) - to help the child manage daily activities, such as holding or picking things up;
• surgery, such as tendon/muscle release, or nerve grafting, which is needed in severe cases of Erb’s palsy to repair nerve damage and restore the ability to move the arm, shoulder or hand. The earlier the surgery takes place, the better the chances of success.

Severe injury to the brachial plexus nerves can cause lifelong disability affecting the injured person’s dexterity, arm and hand strength and mobility, and limiting their ability to participate in certain types of work and leisure activities or handle everyday living tasks for themselves. 

Where obstetric or midwife negligence at birth has resulted in permanent Erb’s palsy disability the best way to maximise the injured persons’ independence and ensure that they have lifelong adequate provision of necessary home adaptations, specialist aids, technology and equipment, therapies, and educational or vocational support, is to make an Erb’s palsy birth injury claim for compensation.

What are the effects of Erb’s palsy?

Each person’s experience of Erb’s palsy will be different, depending on which nerves are affected and the severity of their injury.  Long term effects can range from mild weakness or discomfort to total paralysis of the arm with permanent disability.

Effects of Erb’s palsy may include one or more of the following disabilities:

• total paralysis, weakness or numbness in one arm;
• the arm is held bent at the elbow and close to the body;
• the elbow is held straight and the hand is turned backwards – often called the ‘waiter’s tip’ position;
• smaller sized and different shaped affected arm, from lack of muscle use;
• shorter affected arm from reduced bone growth (as a result of lack of muscle use);
• reduced grip strength or a limp hand;
• drooping eyelid and small pupil of one eye on the affected side – Horner’s syndrome;
• head faces away from the affected arm and can’t face forwards for any length of time – known as torticollis;
• arthritis in later life from abnormal wear and tear on affected joints;
• impaired circulation, muscular and nervous development.

How will Erb’s palsy affect my child’s ability to live and work independently? 

Erb’s palsy disability which causes restricted movement of the arm and shoulder, arm paralysis or weakness and reduced grip strength can make every aspect of life difficult at home, at school and at work. It can also limit the injured child’s ability to participate in some sports and leisure pursuits.

Our clients with Erb’s palsy disability find that independence in routine tasks, like washing and brushing their hair, is one of the hardest things to achieve, owing to the difficulty with raising their injured arm above shoulder height. Cooking also becomes more difficult and dangerous with a weakened or paralysed arm.

At school and then in working life, writing is more difficult without two strong, mobile arms and hands to anchor a piece of paper with one hand and write with the other.  Some study and job options are closed to those with impaired upper limb function or their career progression and earnings may be limited. Driving can also be difficult with many types of Erb’s palsy disability, such as torticollis or a shortened or weakened injured arm. 

Children and young people may require support and counselling to help them cope emotionally with the psychological impact of managing and overcoming their disability in a competitive educational and workplace environment.

We work closely with each client, their family and our experts to understand fully how their life is or will be affected or restricted by their disability. This enables us to ensure that the full, lifelong financial cost of alleviating their hardship and meeting their additional needs is included in their compensation claim.

How can Boyes Turner help my child with an Erb’s Palsy or brachial plexus injury claim?

Boyes Turner’s traumatic birth injury solicitors have secured compensation settlements and awards for many clients with Erb’s palsy from brachial plexus birth injury caused by negligent maternity care.

Our extensive experience of these claims, our understanding of the negligent causes of brachial plexus injury and the lifelong impact of Erb’s palsy on our clients’ lives, and our careful and thorough valuation of each client’s unique disability-related needs enables us to achieve the best settlements.

Where negligent birth injury has impaired our client’s ability to live their life to the full, we work to secure full compensation to alleviate financial hardship, provide necessary care and support, therapies, adapted accommodation and specialist equipment to restore our clients’ independence, financial security and quality of life.

If you would like to find out more about how we can help you or your child make an Erb’s palsy compensation claim, you can contact us to speak to an experienced birth injury solicitor. All enquiries are handled free and confidentially.

You can read more about how we help families make Erb’s palsy birth injury claims here.

You can also read about a life-changing settlement that we achieved for one of our clients with Erb’s palsy brachial plexus injury.

If your child has cerebral palsy or neurological disability as a result of medical negligence, or you have been contacted by HSSIB/MNSI or NHS Resolution, you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.