Erb’s Palsy Causes

Fact Checked

Erb’s palsy is caused by damage to the nerves of the brachial plexus.[1] Damage most often occurs during childbirth, when complications lead to a stretching of the nerves along the neck. Accidents or physical trauma can cause Erb’s palsy at any age.

What Is Erb’s Palsy and What Causes it?

Erb’s palsy is a condition that causes weakness, paralysis, loss of sensation, and limited movement in an arm. It is caused by damage to nerves, called the brachial plexus, that control sensation and movement in the arm.

Anyone at any age can develop Erb’s palsy from physical trauma and nerve damage, but it is most common in newborns.

Shoulder Dystocia and Nerve Damage During Childbirth

Erb’s palsy is caused by damage to the brachial plexus nerves during childbirth. The damage occurs when the head and arm or shoulder get stretched apart.

The nerves run from the spine to the neck and then to the shoulder and down the arm, so pulling or stretching the body in this way also stretches the nerves.

When the baby’s shoulder gets stuck in the birth canal, this is called shoulder dystocia. It can lead to stretching and resulting nerve damage and is a leading cause of Erb’s palsy.

Mild stretching can stress the nerves, which is considered minor damage that will heal naturally and can be helped by physical therapy.

Various childbirth complications can lead to stretching that causes mild to severe damage. A greater degree of stretching can damage the nerves more severely. They can become torn or, in the worst cases, ripped away from the spinal cord.

Manipulating the Baby During Childbirth Can Cause Nerve Damage

Many different factors can lead to nerve damage during childbirth, some involving the doctor or other medical professional manipulating the baby in such a way that the brachial plexus nerves are stretched and become damaged.

For instance, the head and neck may get pulled to the side as the shoulders are delivered from the birth canal. This results from shoulder dystocia, when there are difficulties or delays in pulling the shoulder gently through the birth canal.

Another possibility is that the baby’s head gets pulled while the shoulders are still in the birth canal. Using instruments during difficult deliveries, such as forceps or vacuum, can also cause stretching of the nerves.

Large Babies Are More Likely to Have Erb’s Palsy

When an infant is abnormally large, it can be difficult to deliver through the birth canal. Sometimes, the shoulders can become stuck, creating the need for emergent interventions. This can lead to the head, shoulder, or arm being pulled or tugged in such a way that the nerves get damaged.[2]

If a child is abnormally large, it can usually be detected in the last few weeks of pregnancy. At that point, a doctor must decide if a cesarean section should be done to avoid a difficult birth that can lead to Erb’s palsy and other complications.

Breech Births Can Lead to Erb’s Palsy

A breech birth is another factor that increases the risk of Erb’s palsy. This is a birth in which the baby’s buttocks or feet emerge through the birth canal first, whereas, in a standard delivery, the head comes out first.

Erb’s palsy can occur because, as the doctor pulls the baby’s feet out first, the arms are pulled upward over the head.

This can put stress on the brachial plexus and cause damage. As with a very large baby, a breech position is often detected in advance of labor and may lead to the decision for cesarean section.

Erb’s Palsy During Cesarean Section

A cesarean section (c-section), the surgical delivery of the baby through an incision in the abdomen, is usually done to avoid high-risk births. If a delivery is expected to be prolonged, breech, or to have other significant risk factors, a doctor may decide to perform a cesarean section.

Erb’s palsy is generally not a risk of c-section deliveries, but it may happen in rare cases. Only about 1.5% of cases of Erb’s palsy occur during cesarean section births.[2]

Erb’s Palsy Causes at Any Age

Erb’s palsy is overwhelmingly a condition of childbirth and infancy, but it is possible to sustain injuries to the brachial plexus at any age.

Any accident, violence, or other form of injury that stretches those particular nerves can cause enough damage to trigger Erb’s palsy.

Some of the more common ways someone might injure nerves of the brachial plexus include:[3]

• Contact in sports like football
• Trauma from motor vehicle collisions
• Bullet wounds
• Falls
• Tumors that put pressure on the nerves

What Are the Risk Factors for Erb’s Palsy?

Not all cases of Erb’s palsy have one definitive cause that can be found. There are, however, several risk factors that increase the chance of a baby being born with this injury:

• A breech birth position, which is when the baby is emerging feet first
• A large infant size
• Obesity in the mother
• Diabetes in the mother
• Other birth complications

Does Medical Malpractice Cause Erb’s Palsy?

Negligence, inadequate care, and ultimately medical malpractice can be underlying causes of Erb’s palsy in an infant. If the doctors or other healthcare professionals made mistakes or did not provide good care, your child could suffer a brachial plexus injury during labor and delivery.

For example, forceful pulling on the baby or misuse of tools like forceps can lead to shoulder dystocia and nerve damage. A doctor delaying a C-section can also increase the risk of complications and a resulting birth injury.

What Is the Prognosis for Erb’s Palsy?

Whatever the cause of Erb’s palsy, for infants especially, the damage is usually short-lived. The nerves can often heal naturally, given enough time, and most babies will grow into healthy children with no lasting effects. Most babies have a good prognosis.

For those who have more severe injuries, the results may be permanent. There are several treatment options for moderate to severe Erb’s palsy.

A birth injury lawyer can help you take legal action to recover damages in the case of medical malpractice.