Erb palsy presents in a in a newborn with decreased movement of the involved arm, usually in the "waiter tip" position.
Typically recovers over the course of the first 6 to 12 months of life.
Physical or occupational therapy is used in children with brachial plexus birth palsies to maintain motion and prevent contracture as the nerves reinnervate muscles affected by the initial injury.
Nerve reconstruction or muscle transfer surgery may be needed to improve function in children with incomplete recovery.
A type of brachial plexus birth palsy (a paralysis of the upper extremity due to an injury to the nerves that control movement and sensation to the upper extremity occurring at the time of birth). Often encountered as a consequence of a delivery complicated by shoulder dystocia, Erb palsy typically involves the C5 and C6 nerve roots.
History and exam
Key diagnostic factors
- paralysis of an arm
- observed decreased motion of an arm
- abnormal posture of the arm
Other diagnostic factors
- crepitance of clavicle or humerus
- Horner syndrome
- tachypnea, respiratory distress, feeding difficulties, failure to thrive
- lack of full range of passive movement
- hyperreflexia, persistent primitive reflexes, abnormal muscle tone, or abnormal body posture
- large fetal size (>4000 g)
- shoulder dystocia
- maternal diabetes (especially type 1) or gestational diabetes mellitus
- maternal obesity
- breech presentation
- abnormal second phase of labor
- assisted delivery
1st investigations to order
- x-ray of chest and affected upper extremity (upper extremity "babygram")
Investigations to consider
- ultrasound scan of the shoulder
- MRI of the shoulder
- CT scan of the shoulder
- EMG/nerve conduction studies
- 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
newborns and infants
following initial treatment
Mark J. Adamczyk, MD
Brachial Plexus Treatment Center
Assistant Director of Pediatric Orthopedic Research
Akron Children's Hospital
MJA declares that he is on the speakers' bureau for Orthopediatrics implant company and has received compensation to the Department of Orthopaedic Surgery at Akron Children's Hospital for his involvement. He declares that there is no relation of this agreement to the topic of his BMJ article.
Dimitrios I. Zafeiriou, MD, PHD
Assistant Professor in Child Neurology and Developmental Pediatrics
1st Department of Pediatrics
Aristotle University of Thessaloniki
DIZ is an author of a reference cited in this monograph.
Marybeth Ezaki, MD
Professor of Orthopedic Surgery
UT Southwestern Medical School
Director of Hand Surgery
Texas Scottish Rite Hospital for Children
ME is an author of a number of references cited in this monograph.
Scott H. Kozin, MD
Hand and Upper Extremity Surgeon
Shriners Hospitals for Children
SHK is an author of a reference cited in this monograph.
- Clavicle or humeral fracture
- Septic arthritis of the shoulder or proximal humeral osteomyelitis
- Spinal cord or brachial plexus tumor
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