
SHOULDER SURGERY

	SHOULDER ARTHROSCOPY ARTHROSCOPIC ACROMIOPLASTY ROTATOR CUFF REPAIR TOTAL SHOULDER REPLACEMENT TYPES OF SHOULDER SURGERY
SHOULDER CONDITIONS

	COMPARTMENT SYNDROME SHOULDER ARTHRITIS BURSITIS OF THE SHOULDER SHOULDER TENDONITIS ERB'S PALSY FROZEN SHOULDER SHOULDER FRACTURES ROTATOR CUFF TENDONITIS SHOULDER IMPINGEMENT SHOULDER SPRAINS & STRAINS SHOULDER DISLOCATION
PATIENT RESOURCES

	FREQUENTLY ASKED QUESTIONS BEFORE SHOULDER SURGERY AFTER SHOULDER SURGERY ANATOMY OF THE SHOULDER SHOULDER SURGERY GLOSSARY

Erb's Palsy

What is Erb's Palsy?

You may also hear Erb’s palsy described as brachial plexus paralysis, and though it is most common in newborns, it can occur in adults. Paralysis or limited movement occurs throughout either of the arms as a result of injuries to one or more of the nerves that give us feeling and range of motion in our arms. There are five nerves which can be affected, resulting in minor to major reduction in sensation or movement of an arm. All five nerves that can be damaged and create the condition are part of the brachial plexus, a network of nerves that are attached to the spine from the neck to the middle part of the upper spine. If these nerves are injured in adults, the same symptoms can emerge.

Usually Erb’s palsy will result in infants because of dystocia, difficult presentation and childbirth. A child who is stuck in the head first position (vertex), may have nerves damaged due to pulling on the shoulders. Breech birth can cause the condition too, if the arms are raised above the head and stretched. A few cases occur if the collarbone of the newborn is broken.

What causes Erb's Palsy?

Erb’s palsy is the result of a nerve injury. All the arm’s nerves are connected to a group of nerves near the neck which is called the brachial plexus. The brachial plexus nerves are responsible for feeling and motion in the hand, fingers, and arm.

Erb’s palsy can be caused by several things which can happen during a difficult delivery. Approximately one or two babies per thousand births will have a brachial nerve injury. The brachial nerves can be injured if the baby’s neck and head are drawn to the side when the shoulders exit the birth canal. Pulling excessively on the shoulders as the baby comes out head first can also lead to a brachial nerve injury. During a breech birth (feet first), the arms are usually raised and may be injured from excess pressure.

Improved delivery techniques now prevent many brachial plexus injuries. Larger than average babies are at greater risk for this form of injury; larger than average birth weigh is called macrosomia and is defined as a birth weight of 8 lb, 13 oz or more. A breech birth (the baby presenting abnormally—feet first) also puts the baby at greater risk of injury.

Larger than average babies are especially at risk for a problem during delivery called shoulder dystocia. In shoulder dystocia, the infant’s head is delivered normally, but one shoulder becomes stuck under part of the mother’s pelvic bones. This is a difficult situation for doctors to remedy. The mother’s position will be manipulated in an attempt to free the baby’s shoulder and the doctor will also manipulate the baby within the birth canal. If manipulation and gentle pressure fail, surgery may be needed.

Shoulder dystocia is dangerous to both the mother and the baby. A delivery in which shoulder dystocia occurs is most likely to cause injury to the brachial plexus, resulting in impaired movement of the injured arm.

Women who are short or who have had gestational diabetes are at greater risk for the occurrence of shoulder dystocia. So are women with pelvic abnormalities. Prolonged labor also increases the risk.

Sometimes shoulder dystocia occurs when it anticipated that delivery will be normal. The only thing physicians can do help prevent injury in an unexpected situation is simply to be always prepared for an emergency during delivery and to have a medical team familiar with difficult deliveries on hand during even routine deliveries. Use of forceps or a vacuum extractor should be avoided if possible during delivery, because use of these methods increases the risk of shoulder dystocia. In the case of an extra large baby or a delivery which is expected to be breech, the physician should advice the mother and her family of possible problems and what may be needed to safely deliver the baby.

What are the symptoms of Erb's Palsy?

Arm paralysis
Limp arm
Arm motor control difficulty
Arm sensation symptoms
Arm numbness

How is Erb's Palsy Diagnosed?

A physical exam usually shows that the infant is not moving the upper or lower arm or hand. The affected arm may flop when the infant is rolled from side to side.

The Moro reflex is absent on the side with the brachial plexus or nerve injury.

A careful examination of the clavicle or collarbone will be done to look for a fracture. Sometimes, the infant will need to have an x-ray of this bone.

SURGERY - Nerve Surgery Treatment

A pediatric neurosurgeon may recommend nerve surgery to improve the arm functions for a child with Erb’s Palsy. Often this surgery is more effective when done earlier in the child’s life. Some studies have shown that it may not be successful when done after the child is one year old.

Plastic Surgery Treatment

When nerve surgery is not a viable option, or not successful, plastic surgery may be considered. During plastic surgery for treatment of Erb’s Palsy, certain muscles and tendons are transferred to improve function of the arm. Unlike nerve surgery, plastic surgery for children with a birth injury is usually not recommended until the child is older and the muscles are more developed.