Erb's palsy

Last reviewed: 2 Sep 2022
Last updated: 17 Jun 2022

Summary

Definition

History and exam

Key diagnostic factors

  • paralysis of an arm
  • observed decreased motion of an arm
  • abnormal posture of the arm
More key diagnostic factors

Other diagnostic factors

  • crepitance of clavicle or humerus
  • Horner's syndrome
  • tachypnoea, respiratory distress, feeding difficulties, failure to thrive
  • lack of full range of passive movement
  • hyper-reflexia, persistent primitive reflexes, abnormal muscle tone, or abnormal body posture
Other diagnostic factors

Risk factors

  • large fetal size (>4000 g)
  • shoulder dystocia
  • maternal diabetes (especially type 1) or gestational diabetes mellitus
  • maternal obesity
  • breech presentation
  • atypical second phase of labour
  • assisted delivery
More risk factors

Diagnostic investigations

1st investigations to order

  • x-ray of chest and affected upper extremity
More 1st investigations to order

Investigations to consider

  • ultrasound scan of the shoulder
  • MRI of the shoulder
  • CT scan of the shoulder
  • EMG/nerve conduction studies
More investigations to consider

Emerging tests

  • three-dimensional proton-density MRI to assess the brachial plexus
  • volumetric MRI and EMG assessment of rotator cuff muscles
  • ultrasound evaluation of the brachial plexus

Treatment algorithm

ACUTE

newborns and infants

ONGOING

following initial treatment

Contributors

Authors

Mark J. Adamczyk, MD

Co-Director

Brachial Plexus Treatment Center

Vice-Chairman

Department of Pediatric Orthopedic Surgery

Akron Children's Hospital

Akron

OH

Disclosures

MJA declares that he has no competing interests.

Stephanie A. Russo, MD, PhD

Co-Director

Brachial Plexus Treatment Center

Pediatric Hand and Peripheral Nerve Surgery

Akron Children’s Hospital

Akron

OH

Disclosures

SAR declares that she has no competing interests.

Peer reviewers

Dimitrios I. Zafeiriou, MD, PHD

Assistant Professor in Child Neurology and Developmental Pediatrics

1st Department of Pediatrics

Aristotle University of Thessaloniki

Thessaloniki

Greece

Disclosures

DIZ is an author of a reference cited in this topic.

Marybeth Ezaki, MD

Professor of Orthopedic Surgery

UT Southwestern Medical School

Director of Hand Surgery

Texas Scottish Rite Hospital for Children

Dallas

TX

Disclosures

ME is an author of a number of references cited in this topic.

Scott H. Kozin, MD

Professor

Orthopaedic Surgery

Temple University

Hand and Upper Extremity Surgeon

Shriners Hospitals for Children

Philadelphia

PA

Disclosures

SHK is an author of a reference cited in this topic.

  • Erb's palsy images
  • Differentials

    • Clavicle or humeral fracture
    • Septic arthritis of the shoulder or proximal humeral osteomyelitis
    • Spinal cord or brachial plexus tumour
    More Differentials
  • Guidelines

    • The evaluation and management of neonatal brachial plexus palsy
    • Shoulder dystocia
    More Guidelines
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