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ERB’S PALSY

It’s an unfortunate fact that babies, every day, are born with complications ranging from severe to mild. However, it's possible that some of those complications, like Erb's Palsy (Brachial Plexus and Shoulder Dystocia), could have been prevented. Doctors deliver nearly five thousand children a year who suffer from brachial plexus palsy and ninety percent of the time, Erb’s Palsy injuries are caused by traumatic stretching of the infant's plexus during birth.

Back to the 1700's, physicians described brachial plexus palsy as a paralysis of the arm. Dr. Wilhelm Heinrich Erb, a German neurologist, located the most common injury resulting in brachial plexus palsy, in the nerves present in the vertebrae. A brachial plexus injury (including Complete Brachial Plexus Palsy, Erb's Palsy and Klempke's Palsy) affects a bundle of five nerves known as the brachial plexus, which control muscles in the shoulder, arm, and hand. As a result of this injury, paralysis may occur. Some children have no muscle control or feeling in their arms or hands.

Though doctors cannot predict Erb’s Palsy, certain factors may suggest that certain births face a higher risk of Erbs. Risk factors may include:

• Fetal macrosomia (a baby who is expected to weigh more than 8 lbs. 14 oz)

• Maternal diabetes

• Maternal obesity

• A pregnancy lasting beyond 40 weeks.

• Short maternal stature

• Platypelliod, or contracted or flat pelvis

• Maternal weight gain of 35 lbs. or more

• Protracted first stage of labor

• Breech or other abnormal presentation of a fetus, while not a risk factor, but it can result in such an "injury."

Although Erb's Palsy can occur at any time, most injuries occur during birth. During the strain of childbirth, the shoulder of the baby can get caught and stretched behind the pubic bone. Once the shoulder is caught, the brachial plexus can be compressed, stretched or torn.

The initial symptoms will likely be a limp or paralyzed arm or lack of muscle control in the arm or hand. Erb's Palsy sufferers normally will not be able to lift their arm above their head and will have difficulty gripping with the affected hand. Younger children recover faster from palsy surgery. Injuries that involve nerves below the elbow have a lower rate of improvement because of the location of the nerves and the distance that they need to regenerate.

The goals for a child with Erb’s Palsy are for them to have at least partial use of the affected arm or hand. Feeding one's self or using the affected arm or hand to help the other arm lift and carry things is often a realistic goal. Mild cases usually take 3-4 months to recover; more severe cases will improve slowly over an 18 to 24 month period. In general, by the age of two a child will make no further improvement.

There are treatments that can greatly assist your children in improving from such a condition. Physical therapists will work with children to help increase their range of movement. Performing daily exercise to keep the muscle and joints limber and moving may also help. If the child does not exercise the muscles in the arms and hands, the muscles will remain weak and may not grow normally. Electrical stimulation of muscles is often performed regularly to prevent atrophy. Early treatment for these injuries is crucial in the recovery process. Most parents need to do range of motion exercises at home with their children two to three times a day for several years. Surgery is also an option for those children who do not improve from the above treatments.

Some instances of Erb’s Palsy may have been prevented had the warning signs been properly evaluated. A failure to pick up on such warning signs may be considered negligence if certain actions by the physicians or medical staff could have helped prevent the injury from happening.

Erb’s Palsy cases usually involve one or more of the following issues:

• Failure to estimate the baby's weight before delivery

• Failure to perform a C- section when warranted

• Failure to diagnose and treat gestational diabetes

• Failure to inform parents of the risks associated with delivering a large baby

• Use of excessive force during the delivery

This is not to say that all Erb's Palsy cases are the result of negligence. Often there is little or nothing a doctor could have done. Parents should, however, consider the possibility that a doctor may not have done all that was possible to prevent Erb's Palsy.