Erb’s palsy/ Erb–Duchenne palsy

Overview:
o A form of brachial plexus palsy
o It occurs when there's an injury to the brachial plexus, specifically the upper brachial plexus
at birth.
o The injury can be stretch, rupture or avulsion of the roots
o The commonest birth-related brachial plexus injury
o
o a lesion of C5 & C6 (some time C7 is involved)
o Injuries to the brachial plexus affects movement and cutaneous sensations in the upper
limb.
o Depending on the severity of the injury, paralysis can resolve on its own over a months or
need rehabilitation therapy or surgery.
o Erb’s point located in upper trunk (union of C5 and C6), 2-3 cm above clavicle.
o Affected nerves axillary nerve, musculocutaneous, & suprascapular nerve.

Mechanism of Injury /causes

 Excessive lateral stretching of the baby's head and neck in opposite directions during
delivery. This occurs when the baby is “stuck” in the birth canal.
 Deliver the baby quickly and exert some force to pull the baby from the birth canal.

Risk factors
o Vacuum extraction
o Shoulder dystocia
o Large baby size
o Maternal obesity
o Gestational diabetes
o Prolonged labour
o Breech presentation
o Small or abnormal maternal pelvis shape
o Forceps delivery

Signs and Symptoms

1. Waiter's tip deformity (due to loss of Shoulder ER, arm flexors, and hand extensor
muscles
2. Limb position: IR of the arm, forearm extension and pronation, wrist flexion.
3. Loss of sensation in the lateral aspect of the forearm.
4. Weakness in one arm
5. Partial or total paralysis of supraspinatus and infraspinatus as suprascapular nerve is
affected.
6. In sever Erb’s palsy (deltoid, biceps, brachialis, and subscapular are affected (C5 and C6).
7. Elbow flexion is weakened because of weakness in biceps & brachialis.
8. Paralysis of rhomboids (C5) and serratus anterior (C5, C6, C7), producing weakness in
retraction and protraction of scapula.
9. Neurologic examination (Muscle power, sensation, reflexes- moro reflex is absent).

Diagnosis
o Weakness of the arm and physical examination
o EMG / NCS(to test the integrity of the nerve and muscle fibres)
o MRI or CT (damage to the bones and joints of the neck and shoulder)
o Neurologic examination (Muscle power, sensation, reflexes- moro reflex is absent).

Treatment
o Many children improve or recover by 3 to 4 months of age, sometime it take two years to
recover.

Non-surgical treatment:
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Surgical treatment
-Nerve graft: Replacing a damaged nerve with a section of a healthy nerve that has been
removed from another part of the body.
-Nerve transfer: using a nerve from another muscle as a donor.