Erb's palsy

Question 1

What is Erb’s Palsy

Answer 1

• Generalized muscle weakness in the arm or shoulder due to BrachialPlexus palsy (injury to brachial plexus, particularly upper nerves)
• Usually occurs during childbirth, can occur from traumatic injuries

Question 2

Primary causes of Erbs Palsy

Answer 2

• Avulsion: nerve rips away from spinal cord; Most serious type of Erb’s Palsy
• Rupture: nerve is torn, not from spinal cord
• Neuroma: nerve has torn, healed, but left scar tissue; Scar tissue prevents conduction of signals to muscles
• Neurapraxia: nerve is stretched; Most common type of Erb’s Palsy

Question 3

Erbs Palsy in newborns causes

Answer 3

• During delivery, the head may be shifted, causing the stretching or tearing of brachial plexus
• Erb’s may also develop from the way they lie in the uterus

Question 4

Erbs palsy causes in adults

Answer 4

• MVA, lacerations, contact sports, surgical complications, or tumors

Question 5

Signs and symptoms of Erbs palsy

Answer 5

• Paralysis or limpness of shoulder, arm, and elbow
• Numbness/tingling in arm or hand
• Reduced grip strength
• “Waiter’s tip” hand position: Pronated, flexed wrist, lax fingers
• Diminished C5-C6 reflexes

Question 6

How is Erb’s Palsy diagnosis

Answer 6

• Order an x-ray, ultrasound, or MRI to evaluate bones and joints of neck and shoulder due to nerve injury
• EMG or nerve conduction tests
• Sensory changes in peripheral nerves of UE

Question 7

PT management of Erb’s palsy

Answer 7

• Smooth joint movements: passive and active ROM exercises and gentle stretching
• Strengthening exercises for the affected muscles
• Sensory stimulation: stimulating the skin with various textures, temperatures, brushing techniques, and vibrations to aid in restoration of sensation
• Electrical stimulation: promotes improving muscle strength and mobility of affected limb
• Constraint Induced Movement Therapy: intensive therapy in which the individual’s non-affected UE is placed in a cast so the individual must use their affected limb to perform most daily tasks
• Bimanual activities: improves coordination and prevent limb disuse
• Aquatic therapy

Question 8

Other Forms of treatment for Erbs palsy

Answer 8

• Botulinum Toxin injections
• Splints and orthotics
• Surgical Interventions: Nerve reconstruction surgery, Nerve transplant, Tendon transfers
• Notably, treatment for Erb’s Palsy is often managed by physical therapists, occupational therapists, primary care physicians, and potentially neurosurgeons
• In cases with infants and children, parent education is key to encourage activities to be done at home to aid with recovery

Question 9

Long term complications of Erb’s Palsy

Answer 9

• Decreased muscle strength and stamina
• Abnormal movement and joint function
• Atrophy
• Impaired bone growth
• Osteoarthritis
• Limb length Discrepancy
• Balance impairments⁶