Erb's palsy

What is Erb's palsy?

Erb's palsy is a specific form of brachial plexus injury affecting the upper nerves of that bundle, which control the shoulder and upper arm.

The characteristic presentation is an arm held limp against the body with the forearm rotated inward, sometimes described as a waiter's tip position.

It is typically identified shortly after birth when the newborn does not move one arm normally.

It is named for the physician who described the pattern, and it remains among the more recognizable birth related injuries.

How does it occur during delivery?

The mechanism involves stretching of the nerves as the baby passes through the birth canal.

Each mechanism involves force applied to the head while the shoulder remains fixed.

• Excessive lateral traction on the head during delivery
• Difficulty resolving shoulder dystocia
• Improper technique in freeing an impacted shoulder
• Use of vacuum or forceps assistance
• Delivery of a large infant through a difficult passage

What is the prognosis?

It varies substantially with the severity of the nerve damage. Milder stretching injuries frequently resolve over months with physical therapy.

More severe injuries, including tearing of the nerve or avulsion from the spinal cord, can leave permanent weakness, limited range of motion and growth differences in the affected limb.

Surgical repair is possible in some cases and is generally considered within a defined window during infancy, which makes early evaluation important.

Occupational therapy alongside physical therapy is common, since function in daily tasks matters as much as raw strength.

When does it support a claim?

Not automatically. Brachial plexus injuries can occur even with appropriate technique, particularly where dystocia was unanticipated.

The question is whether the delivery team recognized risk factors, prepared appropriately and used recognized maneuvers rather than excessive traction.

The delivery record is central. What maneuvers were performed, in what order and over what period establishes whether the response met the standard of care.

Documentation of estimated fetal weight and any diabetes management during pregnancy is therefore obtained alongside the delivery notes.

Common questions

Will my child recover?

Many milder injuries resolve substantially with therapy over the first months. Severe injuries may leave lasting effects, and a pediatric specialist can assess the specific situation.

Does Erb's palsy always mean negligence?

No. These injuries can occur despite appropriate care. Whether this one involved a departure from standards requires review of the delivery record.

How soon should the delivery record be reviewed?

Promptly. New Jersey applies a distinct deadline to birth related claims, and surgical options also have their own timeframes.

Should we see a specialist even if it seems to be improving?

Discuss it with your paediatrician, since surgical options for more severe injuries are generally considered within a defined window during infancy. Early specialist assessment establishes a baseline and identifies whether the recovery is following the expected course, which matters clinically as well as for any claim. Documenting function with photographs and video over time also helps establish the practical effect.