Erb's Palsy

Hi C.

My son was stuck under my pelvic bone and had a very traumatic birth. He also had Erb's Palsy. With my son he had no use of his left arm...it just dangled. He also had issues with his suck/swallow reflex. He was unable to nurse b/c he couldn't suck properly and had issues with bottles. he would try to drink and milk would spray out the side of his mouth b/c of lack of muscle/nerve control. We put him in PT and he was crawling by 9 months old and is 100% today. I do know that sometimes Erb's Palsy is temperoray and sometimes it is permanent. I hope things work out well for your baby.

I so remember the feeling...my daughter also had a rough delivery and inturn has Erbs Palsy affecting her right arm. This was my first child and really tried to do everything right during my pregnancy only for it to come down to a difficult delivery. I still remember how upsetting the news was from the physical therapist only hours after her delivery. They always give you the darkest outlook and %'s of nerve regeneration. I remember how we would pin the sleeve of her onsie to the front of her to keep it from dangling. It dangled until she was around 5 months old. We also started physical therapy not long after birth and continued through about 2 years of age. Her therapy consisted of deep massage and stretching. Then once she was old enough we had arm excerises and still massage. I can remember so much time spent in our closet letting her hang from the second row of cloths rods. Or pushing the shopping cart in the grocery store with both arms extended. She had trouble crawling because of the weekness in her shoulder which is why I think she was walking at 9 months. Today she is 10 and although there are things they said she would never do...it has never held her back. After countless hours on the monkey bars for therapy to strengthen the arm and shoulder she can still do them faster than anyone! She is right handed but uses her left arm to swing a bat or tennis racket and has trouble doing lay-ups on that side in basketball. She loves sports and is very active. She does have a degree of permanent elbow contracture(she can not completely straighten her arm)but no one would ever know except for her Dad and I. Her right scapula is out of line because the nerves are not strong enough to hold it in place but, again no one would ever know but us. She was about 7 before we ever discussed it with her and only at that point did she say oh! that's why I can't straighten my arm or prefer to swing left handed. Life got busy and it never seem to affect her and we just never discussed it. It was not something that we were intentionaly keeping from her. I so know it is hard to look at your beautiful angel and hate the struggles she faces. There were so many times I got tired of going to therapy and wondered if it was even helping. But as you said stay positive and it WILL get better in time.

I am 19 and have Erb's Palsy. When I was born their was nothing they could do to help. I still havent been able to find a Doctor that can succsesfully operate on a young adult. The best is to start working on it young. Thier is a Doctor in Texas named Dr. Nath that specializes on Children with Erb's Pasly the outcomes of the surgery are amazing!

Hi - just wanted to let you know of a website - cafemom.com. There are a million different groups - you could try looking up erbs palsy - they could definately be a group for that. It is kind of like mamasource except you have support groups for specific things. Good luck!

I personally dont know this but this is what I found online
Erb's palsy is a form of brachial plexus palsy.

Erb's palsy leads to a weakness of a newborn baby's arm. It is caused by a stretch injury to the brachial plexus (BRAY-key-el PLEK-sis). The brachial plexus is a network of nerves near the neck that give rise to all the nerves of the arm. These nerves provide movement and feeling to the arm, hand, and fingers.

One or two of every 1,000 babies have this condition. Most infants with brachial plexus birth palsy will recover both movement and feeling in the affected arm. Parents must be watchful and active participants in the treatment process to ensure maximum functional recovery.

Anatomy

This infant has brachial plexus birth palsy. The arm is rotated inwardly (internal rotation) toward the body and the infant cannot move the arm effectively.
(Courtesy of Texas Scottish Rite Hospital for Children)The brachial plexus is formed as the nerves to the arm, hand, and fingers pass from the spinal cord between the bones (vertebrae) of the neck and go into the arm. Along the side of neck, these nerves merge together. From there, they branch out to form a "highway system," or "plexus," of nerves.

This system of nerves then travels below the collarbone (clavicle) and spreads out into the arm. The nerves that go to the shoulder lie higher in the neck than those that travel to the hand and fingers. Nerves that provide feeling to the hand and fingers lie lower in the neck, just above the chest.

There are many nerves in the brachial plexus. Each nerve contains many little nerve fibers with layers of "insulating" tissue.

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Cause
Brachial plexus stretch injuries in newborns usually occur during a difficult delivery, such as with a large baby, a breech presentation, or a prolonged labor. It may also happen when the person assisting the delivery must deliver the baby quickly and exert some force to pull the baby from the birth canal. If one side of the baby's neck is stretched severely, the nerves may also be stretched, causing the injury.

Most often, it is the upper nerves that are affected. This brachial plexus birth palsy is known as Erb's palsy. The infant may not be able to move the arm, but may be able to move the fingers. If both the upper and lower nerves are stretched, the condition is usually more severe than just Erb's palsy. This is called a "global," or total, brachial plexus birth palsy.

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Symptoms
In general, there are four types of nerve injuries. One infant may have one or more types of injury.

A stretch injury that "shocks," but does not tear, the nerve is the most common type. This is called a neurapraxia (new-rah-PRAK-see-ah). Normally, these injuries heal on their own, usually within three months. Neurapraxia is not limited to infants. It can happen in adults as well. For example, when it happens to football players who are injured during play, they call this '"burners and stingers.''

A stretch injury that damages some of the nerve fibers may result in scar tissue. This scar tissue presses on the remaining healthy nerve. This condition is called a "neuroma." Some, but not total, recovery usually occurs.

A stretch injury that causes the nerve to be torn apart (ruptured) will not heal on its own. A rupture happens when the nerve itself is torn.

The fourth type of injury, an "avulsion," happens when the nerve is torn from the spinal cord. Nerve ruptures and avulsions are the most serious types of nerve injury. It may be possible to repair a rupture by "splicing" a donor nerve graft from another nerve of the child. It is not possible to repair an avulsion from the spinal cord. In some cases, it may be possible to restore some function in the arm by using a nerve from another muscle as a donor.

The symptoms of a nerve injury (loss of feeling and partial or complete paralysis) are the same, regardless of the type of injury. It is the severity of the injury that affects both treatment decisions and the extent of recovery possible.

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Diagnosis

This toddler has brachial plexus birth palsy. It has caused a weakness of the right arm. The child is unable to raise the right arm overhead when reaching for an object.
(Courtesy of Texas Scottish Rite Hospital for Children)A pediatrician will usually be the one to make the diagnosis of a brachial plexus palsy injury, based on weakness of the arm and physical examination. A doctor may order an X-ray or other imaging study to learn whether there is any damage to the bones and joints of the neck and shoulder. The doctor may also do some tests to learn whether any nerve signals are present in the muscle of the upper arm. These tests may include an electromyogram (EMG) or a nerve conduction study (NCS).

Because most newborns with brachial plexus birth palsy recover on their own, the baby will be re-examined frequently to see if the nerves are recovering. It may take up to two years for complete recovery. During this time, the parent will be taught how to do exercises with the baby to protect the soft joints and to keep the baby's arm in good condition.

Sometimes, the affected arm is noticeably smaller than the unaffected arm. This occurs, in part, because the arm is not used as much. This also occurs because normal nerves do have an effect on growth. Although the size difference is permanent, the arm will still grow until the child stops growing.

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Treatment
Nonsurgical Treatment
Because a baby cannot move the affected arm alone, it is important that parents take an active part in keeping the joints limber and the functioning muscles fit. Daily physical therapy and range of motion exercises, done as often as possible during the day, begin when the baby is about three weeks old. The exercises will maintain the range of motion in the shoulder, elbow, wrist, and hand. This will prevent the joint from becoming permanently stiff, a condition called a joint contracture.

Surgical Treatment

Weakness of the left shoulder, arm, and hand persist in this young child with brachial plexus birth palsy.
(Courtesy of Texas Scottish Rite Hospital for Children)If there is no change over the first three to six months, the doctor may discuss exploratory surgery on the nerves to improve the potential outcome (prognosis). Nerve surgery will not restore normal function, and is usually not helpful for older infants. Because nerves recover very slowly, it may take several months, or even years, for nerves repaired at the neck to reach the muscles of the lower arm and hand.

Many children with brachial plexus injuries will continue to have some weakness in the shoulder, arm, or hand. There may be surgical procedures that can be performed at a later date that might improve function.

The doctor will discuss the various treatment options and make a specific recommendation based on each child's individual situation. Do not hesitate to ask questions. There is much that parents can do to help ensure a good return of function.

Children are very adaptable. Parents should be supportive and encouraging, focusing on what the child can do. This will help a child develop a healthy sense of self-esteem and compensate for any limitations in function