Frequently asked questions
What is Erb’s Palsy?
The word ‘palsy’ in plain English means ‘paralysis’.
Erb’s palsy is an injury most often caused to a child during the birth process.
The injury is caused by damage to the group of nerves that branch out from the spinal cord in the neck and then pass across the shoulders and along the arms to the tips of the fingers. The nerves affected are responsible for controlling movement of the arms, hands and fingers.
What are the causes of Erb’s Palsy?
The injury is most often caused during the birth process.
It arises most commonly, although not exclusively, from delivery of the baby’s shoulder during a difficult birth (shoulder dystocia). There may be a need to deliver the baby quickly, and Erb’s palsy may therefore be the result of a medical emergency.
There are certain risk factors which may mean that a mother is at increased risk of shoulder dystocia, for example if the mother has an unusually small pelvis, or if the baby is larger than average.
Commonly, the child’s shoulder is lodged behind the mother’s pelvis which results in the use of force to deliver the baby. This can result in the tearing of muscles and nerves in the area of the shoulder.
Most hospitals have a policy for dealing with births where there is difficulty delivering the shoulders of the baby, and if these are available, established protocols should be followed. These include positioning of the mother in a certain way during delivery, applying pressure to the pubic area and applying traction in a particular way to the baby as it is being delivered.
Erb’s palsy as a result of labour in the UK is relatively rare, occurring in the region of 1 in 1,800 births.
What are the symptoms of Erb’s Palsy?
Several factors affect how severe the injury is. The number of nerves that have been affected will influence the extent of the injury. It may be the case that only one nerve is affected, or all five of the nerves that supply movement and feeling to the arm may be affected. The purpose of these nerves is to transmit electrical impulses, thereby giving movement and feeling to the arm and hand.
Another factor is the extent of the damage to the nerves affected.
A classic sign of Erb’s palsy is an elbow that does not bend, and the hand is held in a ‘waiter’s tip’ position (ie turning backwards). The hand may be limp. The baby may also experience some sensory loss in the affected hand and arm. In more severe cases the baby may be unable to face forward for any length of time and face away from the affected arm.
How is Erb’s Palsy diagnosed?
The diagnosis can be made by a paediatrician based on the presence of weakness of the arm and on physical examination. An xray may be performed to determine whether there has been any damage to the bones and joints of the neck and shoulder. Further tests can be performed to establish whether the nerve signals are present in the muscles of the upper arm.
What are the treatment options for Erb’s Palsy?
Depending on the nature of the damage, the paralysis can either resolve on its own over a period of months, necessitate rehabilitative therapy or require surgery.
Treatment falls into two categories, surgical and non-surgical
Non-surgical treatment begins when the infant is around 3 weeks old. This involves mainly exercises which are carried out frequently during the day. The exercises will help to maintain the range of motion in the shoulder, elbow, wrist and hand. This will prevent the joints from becoming permanently stiff. Involvement of physiotherapy services is usual.
It may take up to two years for complete recovery to occur.
Surgical treatment may be necessary to provide the best outcome. This is often performed at around 3 – 6 months of age if there has been no response to non-surgical treatment. Because nerves recover very slowly, it may take several years for nerves repaired at the neck to reach the muscles of the lower arm and hand.
Additional surgical procedures may be performed at a later date to further improve function.
When might I have a claim for Erb’s Palsy?
You may have a claim for clinical negligence if the cause of the Erb’s Palsy was negligent medical treatment. In order to show that the treatment received was negligent, it is necessary to prove that the standard of care provided fell below a reasonable standard, and that the substandard part of the treatment caused the damage.
There are many circumstances in which negligent medical care may have caused Erb’s Palsy.
The extent of compensation will depend on the severity of the Erb’s Palsy, and the impact it has on the individual affected.
Compensation can also include an amount awarded for pain and suffering, as well as the costs of any treatment required as a result of the injury.
Our team of clinical negligence solicitors have a wide range of experience in progressing claims of this nature, and will be happy to advise, in the first instance, whether you may have a claim for clinical negligence.