June 3, 2019

What you need to know about Erb’s palsy

Erb’s palsy, or brachial plexus palsy, is a condition where a baby has suffered damage to the nerves in the neck which control the arm due to an injury at the time of birth. These nerves are called the brachial plexus and they carry information, like an internet cable, between the brain and the arm about movement, feeling, touch and pain. They also stimulate growth and make skin sweat and hairs and nails grow and function properly.

The damage caused to these nerves results in an arm which is floppy at birth and won’t move, it can be dry and is probably rather numb. Slowly over time the injury recovers but most children tend not to recover full function naturally.

How was my child injured and was it preventable?

Nerves really don’t like to be stretched; they are not very elastic and tend to break if pulled too hard and too quickly. The most common way babies get brachial plexus injuries is when they get stuck during birth (shoulder dystocia) and in delivery the nerves get stretched and pulled. The birth process can also bruise your child or break bones in, or around the arm.

This is a very difficult question and one every parent with a child with Erb’s palsy has asked, if not out-loud then certainly in their heads. It is a complicated one to answer too as in life when things go wrong it is part of the process of putting things right to understand how things went wrong. Sometimes there were things that went wrong that could have been done better, sometimes it was just one of those awful things that came out of the blue and could not have been stopped.

If it was preventable then the next question asked is often whose fault was it. This again is not easy to answer. If you have questions regarding this then you can speak with the clinicians (midwives/doctors) to discuss what happened at the time of the birth and advice from lawyers with experience in this may also help you.

Will my child get better and can surgery help?

Almost all babies who are injured in this way recover some function naturally. The injury is at its worst when you first see your baby directly after birth; almost all children will improve from this point. There are three main forms of Erb’s palsy. The most serious kind of Erb’s palsy is when the nerve is pulled out from the spine, known as an avulsion injury. This sadly means there is no chance that healing will happen on its own but there are surgical treatments that may be possible.

Another form of Erb’s palsy which I see is a rupture injury (where the nerves are snapped). With this type of EP there may be recovery by nerve regrowth and this may be good or very poor. Again here there are many options for treatment.

Finally, there is a mild kind of Erb’s palsy where the nerve is initially stunned and fortunately, with this form of Erb’s palsy, complete recovery is common.

In some cases, recovery can be helped by surgery.

It is difficult to be absolutely sure what recovery is going to come through and different medical and therapy teams around the world use different methods. It is then harder still to choose surgery and be sure it is going to improve upon what is likely to happen by natural recovery. This is why it is important to talk to your treating team and ask questions about what treatment is available and then talk through your teams’ answers with them to help you make the right decisions for your child. You must remember there are risks to any treatment but there are also risks of not having treatment.

Should my child have surgery though?

It is always a difficult decision to make to undertake surgery on a child. We make decisions for our children all the time, but this one is often very stressful. The only advice experts can give to everyone is that you have to understand, from conversations with your treating team, what they think will happen if no surgery is undertaken and what the best case and worse case outcome from surgery will be. Then it is important to do your own reading and research, to make sure all your questions are answered before making any decision.

None of this surgery is life-saving, it does not have to be done, but often it offers a benefit. This benefit for nerve surgery is often time dependent; meaning you have to make a decision within a time frame, often before five or six months of age. There are other kinds of surgeries on the shoulder or arm which can be done at any time and there is no time by which is has to be done.

Will my child be able to lead a normal life?

Yes, but with certain limitations. Unless your child has other medical problem s/he will live a full life that is very similar to what it would have been if the injury would not have happened. Children who have this condition adapt very well, much better than an adult would do if suddenly faced with the same issues, as they have grown up to find their own ways to do things.

Certain jobs or tasks will be impossible for your child to perform (depending on the extent of the injuries). Often careers in the military or police maybe excluded. Some day-to-day tasks which require the use of two perfectly working hands may be difficult for the child to perform but they usually find a means to get everything done in their own way.

Is there a cure expected for Erb’s palsy injuries soon?

At the Peripheral Nerve Injury Research Unit and the University College London Centre for Nerve Engineering they are working very hard on research in to the way nerves heal. They are working towards:

  • developing a drug to help nerve recovery
  • how to detect which injuries will best benefit from surgery
  • how to make a new nerve graft in the lab but with the child’s own cells, so we don’t have to take nerves from other part of the body to repair the injury.
  • how to train the body better to improve function and reduce pain.

They are also engaged in supporting and teaching with midwives and obstetricians as the best cure for Erb’s palsy is prevention. If it does occur getting the right treatment as soon as possible is vital. They want the profile of this injury to be raised and education and information to be freely available to all, with early and clear pathways to referral for specialist help from a full team of trained experts.

The question of whether an EP injury is preventable is a difficult one but one that we investigate and successfully pursue on a regular basis.

If you believe your child’s injury may have been preventable then s/he may be entitled to compensation for that injury.

To find out more about the legal and practical challenges relating to Erb’s palsy, and how professional help can ensure you’re prepared to face them, join us for our next Erb’s Palsy Legal Clinic on 11 March 2020.

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