Erb’s Palsy and Brachial Plexus Injuries

Erb’s palsy, is a type of nerve injury that causes paralysis in the shoulder and arm. It is sometimes referred to as Brachial plexus palsy.

There is a network of nerves, called the brachial plexus that runs from your neck, into your shoulders and arms. If your baby’s brachial plexus nerves are injured by stretching, tearing or other trauma it can cause serious, sometime permanent injury.

Most Erb’s palsy injuries happen when your baby gets stuck in the birth canal during delivery. This is referred to by doctors as shoulder dystocia and it is a medical emergency. A brachial plexus injury can happen if your doctor or nurse applies too much force to your baby when trying to pull your baby out of the birth canal.

Types of Brachial Plexus Injuries

There are 3 different types of brachial plexus injuries that are dependent on the amount of force applied to your baby’s shoulder.

• Neuropraxia: This type is injury is caused when scar tissue buids up around a nerve after it has been pulled, stretched or torn. The scar tissue interferes with the ability of the nerve to transmit nerve signals. Surgery can remove the scar tissue and restore nerve function;
• Rupture: This happens when the brachial plexus nerve is torn. In order to correct a ruptured nerve a surgeon will have to do a nerve graft which links the gap created by the torn nerve;
• Avulsion: This is the most serious form of brachial plexus injury and it is the only injury that is properly described as Erb’s Palsy. An avulsion injury happens when the root of the nerve is completely torn away from the spinal cord. This type of injury typically requires a complete nerve graft in order to create a new nerve path.

Effects of Erb’s Palsy

Some Erb’s Palsy injuries may heal on their own or they may require surgery to repair. Some children can be left with significant life-long disabilities due to Erb’s Palsy.

Erb’s palsy can cause weakness and disability in your baby’s shoulder, arm and hand. Many Erb’s palsy injuries can cause permanent paralysis of the arm and shoulder.

Can Erb’s Palsy Be Prevented?

In order to prevent Erb’s Palsy it is important to know what risk factors make it more likely for shoulder dystocia to happen. Then your doctor can take steps to expedite your labour to decrease the risk of shoulder dystocia. Some of the risk factors that can lead to shoulder dystocia and Erb’s palsy:

• A prior delivery where your baby had shoulder dystocia;
• There is an increased risk of shoulder dystocia when drugs like pitocen or syntocin are used to speed up your labour;
• Moms who have diabetes are at greater risk of shoulder dystocia;
• Larger babies (greater than 3.8 kilos) have an increased risk of getting stuck and encountering shoulder dystocia;
• Some mothers have an unusually small pelvic opening (this is called cephalopelvic disproportion) and it means your baby may be more likely to get stuck during delivery;
• Longer labour tends to increase the risk of shoulder dystocia;
• The is an increased risk of shoulder dystocia when your baby is in breech (feet first) position;
• Finally, if your baby’s head is turned the wrong way during delivery this can lead to dystocia.

What Can You Do to Reduce the Risk of Erb’s Palsy?

The most important thing you can do to prevent the chances that your baby will suffer shoulder dystocia leading to Erb’s Palsy is to have a discussion about your risk factors with your obstetrician.

You may want to discuss whether your baby can be delivered a few days early.

If your baby gets stuck because of shoulder dystocia there are a number of techniques or maneuvers your doctor can use to safely deliver your baby. Doctors who have proper training are less likely to injury your baby during delivery.