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Erb's Palsy Treatment

Erb’s palsy is another name for Erb-Duchenne paralysis. It’s among the most common birth injuries and sometimes occurs as a result of a difficult delivery. The appropriate treatment depends on the severity of the damage.

This condition affects the brachial plexus, which is a complex network of nerves that provides motor and sensory function to the arm. It’s located near the neck and shoulder. Patients with Erb’s palsy have damage to the upper part of the brachial plexus, while those with a more severe condition known as total brachial plexus birth palsy have damage to both the upper and lower parts.

Depending on the severity of the injury, the condition may resolve, require rehabilitative therapy, or lead to surgery.

Often, the affected arm is immobilized for the first week, to help the nerves heal. The baby may then receive physical therapy, which is intended to increase the range of motion.

In many cases, the nerves will heal on their own in three to five months. However, some babies may need surgery. In rare cases, children may face permanent disability.

Causes of Erb’s Palsy

Major risk factors include a difficult birth due to an unusually large baby or the mother’s small cervix or pelvis. Other factors include the method of delivery used. In addition, there are several other likely causes of Erb’s palsy, which results from torn and damaged nerves. In the worst cases, one or more nerves detach from the spinal cord.

Here are some common causes of Erb’s palsy:

Neuropraxia
In babies with neuropraxia, the nerve is stretched, but not torn. This is the least severe form of Erb’s palsy, and the most likely to heal on its own over time. Most children recover full function of the affected arm.

Neuroma
A neuroma is a piece of scar tissue that presses on a nerve and interferes with the nerve’s function. A neuroma may form as a nerve heals from an injury. Physical therapy can be helpful, but it may be necessary to remove the scar tissue surgically in order to relieve the symptoms.

Rupture
In a rupture, one or more nerves have completely torn, but not at the level of the spinal cord. Ruptured nerves often don’t heal completely on their own. Surgery, such as a nerve graft or nerve transfer procedure, is often helpful for patients with this form of Erb’s palsy. Most affected children will regain a good level of function following the procedure, although they may experience some lasting effects.

Avulsion
In an avulsion, the nerve has been torn completely away from the spinal cord. This is the most severe form of Erb’s palsy and the most challenging type to treat. Affected children may need surgical intervention in order to regain function in the affected arm. This is often effective, but patients may continue to experience some lasting effects from their injury.

Physical Therapy for Erb's Palsy

Physicians often prescribe physical therapy for infants with Erb’s palsy. As the most common treatment type, it’s used for even the most minor damage. Physical therapy involves completing a series of exercises to strengthen muscles in the area and support the body in healing nerve damage. Designed to increase the range of motion, these exercises are gentle, promoting natural movements and aiming to restore full arm functionality.

Although not part of a physical therapy regimen, recreational play can also help restore functionality. Some parents hold back from involving their child in play once they have received a nerve damage diagnosis. However, most movement and exercise will only benefit the injury.

Growing children recovering from Erb’s palsy can engage in activities that promote development. These activities include climbing, swimming, throwing, and crawling.

Some physical therapists may recommend using tape, braces, or splints to encourage proper alignment and train your baby’s wrist, arm, hand, and shoulder to move in natural anatomical ways. In some cases, your child may need these devices to prevent deformities that can get in the way of future treatment.

Occupational Therapy for Erb's Palsy

Occupational therapy supports the development of fine motor skills and helps a child with Erb’s palsy to lead a full life. Occupational therapists take a slightly different approach than physical therapists by focusing on daily tasks and real-life situations. Over time, occupational therapy may help babies regain full use of their arms and fingers.

Physical and occupational therapy are synergistic, and it’s often beneficial to use both types of treatment at the same time. Physical therapy helps to develop gross motor skills, strength, and range of motion, while occupational therapy helps to develop fine motor skills and coordination. Because babies can’t perform therapy exercises by themselves, both types of therapy are also a good way for parents to bond with their babies, and both parent and baby often enjoy the therapy sessions.

Occupational therapy supports the development of fine motor skills and helps a child with Erb’s palsy lead a full life. Occupational therapists take a slightly different approach than physical therapists by using daily tasks and real-life situations. Over time, occupational therapy may help babies regain full use of their arms and fingers.

Physical and occupational therapy are synergistic, and it’s often beneficial to use both types of treatment at the same time. Physical therapy helps to develop gross motor skills, strength, and range of motion, while occupational therapy helps to develop fine motor skills and coordination. Because babies can’t perform therapy exercises by themselves, both types of therapy are also a good way for parents to bond with their babies, and both parent and baby often enjoy the therapy sessions.

Hydrotherapy Treatment for Erb's Palsy

Hydrotherapy is a type of physical therapy that involves being in a pool. The water supports the baby’s arm, helping to relieve strain. The natural resistance of the water also helps to develop strength. Hydrotherapy may involve performing organized physical therapy exercises in the pool, or it can be more relaxed, simply involving playing in the pool with your child.

Hydrotherapy is a type of physical therapy that involves being in a pool. The water supports the baby’s arm, helping to relieve strain. The natural resistance of the after also helps develop strength. Hydrotherapy may involve performing organized physical therapy exercises in the pool, or it can be more relaxed, simply involving playing in the pool with your child.

Surgery for Erb's Palsy

Unfortunately, therapy alone doesn’t always lead to a complete recovery. In some cases, babies also require surgical corrections. Surgery can help to restore feeling and movement in the injured arm. There are numerous potential surgeries, and the one that’s right for your baby will depend on the severity of the damage.

More minimally invasive procedures repair the damaged nerve with relatively little trauma. However, other surgeries might be required depending on the severity of the condition. 

Nerve graft:
This involves removing nerves from elsewhere in the child’s body and using them to support the weakened brachial plexus nerves.

Nerve decompression:
This procedure releases tissues that may be putting pressure on nerves, such as scar tissue.

Following minimally invasive or more involved surgeries, your child will need plenty of time to recover, along with physical therapy to retrain the muscles and nerves and improve range of motion.

Alternative Therapies for Erb's Palsy

While traditional treatments such as physical therapy and surgery remain at the top of the list of treatments for Erb’s palsy, physicians may also recommend other treatments. Alternative forms of treatment include neuromuscular electrical stimulation and Botox.

Neuromuscular Electrical Stimulation
Neuromuscular electrical stimulation (NMES) uses a small electrical current to stimulate muscles in the affected area. NMES may improve blood flow to the injured area as well as build muscle. Studies suggest that NMES is helpful for babies with Erb’s palsy, although it hasn’t yet been definitively proven to be effective.

Botox
Botulinum toxin A, better known as Botox, temporarily paralyzes muscles at the injection site. Doctors might recommend Botox to immobilize primary muscles to give your baby’s weaker muscles a chance to develop more quickly.

Theoretically, Botox may improve your child’s flexibility by forcing weaker muscles to compensate for stronger ones temporarily paralyzed by the injection. As a word of caution, as with so many other treatments for Erb’s palsy, few studies have shown how effective Botox treatments may be. Botox wears off within three to four months, at which point normal muscle function returns.

Potential Costs of Erb's Palsy Treatments

The costs associated with traditional treatments, such as occupational and physical therapy, and nontraditional therapy, such as Botox and NMES, vary greatly. While insurance may be more inclined to pick up surgical expenses, it’s a good idea to check with your insurance company to see what types of treatment are covered.

Between copays and out-of-pocket expenses, the overall treatment for Erb’s palsy can become very expensive. The cost may exceed the budgets of many families.

Your Legal Options for Erb’s Palsy Birth Injuries

It is imperative to know if your child’s condition could have resulted from mistakes made by medical professionals during delivery. For example, a doctor might use too much force and stretch the baby’s nerves too far. Therefore, it’s important to speak with a birth injury attorney to find out if you may be eligible to recover the expensive cost of treatment.

Contact us at Birth Injury Center to schedule a free consultation for legal assistance if you think your child’s Erb’s palsy was a result of medical negligence.