Erb’s palsy is a brachial plexus injury that heals without any kind of treatment in about 80 to 90 percent of cases. Erb’s palsy may affect the muscles, nerves, and other tissues in the arms and hands, causing paralysis, weakness, and issues with mobility and sensory perception. Treatment and therapy may help infants with Erb’s palsy to recover maximum function in the arm that is affected.
Who Should Treat Erb’s Palsy?
Treatment for Erb’s palsy is often more effective when a multidisciplinary approach is used. Specialists such as orthopedic surgeons, neurologists, physical therapists, and occupational therapists may work together to formulate an Erb’s palsy treatment plan. If all of these specialists cannot be accessed for Erb’s palsy treatment, working with a pediatric neurologist is recommended. A neurologist will be able to track the progression of treatment, recommend treatment methods, and give the best advice for at-home care.
Non-Surgical Treatment Options
Range of motion exercises and massage are helpful in most cases of Erb’s palsy. These physical therapy options may be the only treatments necessary for mild to moderate cases of Erb’s palsy. These treatments may also help to prevent worsening complications, such as joint contractures and decreased flexibility in cases ranging from mild to severe. Electrical stimulation is also used as Erb’s palsy treatment in some cases.
Botox Injections
Botox injections directly into the affected area can sometimes be helpful in treating Erb’s palsy. Botulinum toxin causes temporary muscle weakness by blocking the pathway between the nerve and the muscle. This can allow weaker muscles to strengthen by inhibiting the ability of the stronger muscle to take over during movements. This can also allow stronger muscles to relax and stretch and may be helpful in increasing the length of muscles. Botox is only effective when used in combination with exercises and stretches.
Surgical Treatment Options
If function does not return to the arm that is affected by Erb’s palsy in about six to eight weeks, surgery is recommended. Surgery is generally most effective when performed within the child’s first year of life. In severe cases of avulsion or rupture, non-surgical treatments are unlikely to be effective, so doing surgery as soon as possible will often yield the best results. Microsurgery may allow reconstruction of some of the nerves of the brachial plexus, which can sometimes result in a full recovery from Erb’s palsy.
Exploratory Surgery
Nerve grafts and nerve transfers may help to remove scar tissue and repair damaged nerves. In nerve grafts, the damaged nerves are replaced or spliced together with nerves that have been taken from donor sites. In nerve transfers, a nerve from another muscle is transferred to the affected area. These surgeries are followed up with physical therapy. Results may vary, with some children making a full recovery and others only regaining some function.
Erb’s Palsy Prognosis
Erb’s palsy prognosis varies depending on the severity of the injury, the location of the injury, and the presence or absence of other complications and injuries. Mild and temporary cases of Erb’s palsy often resolve with little to no treatment within three to six months after birth. Slightly more severe cases typically resolve within one year. Even severe cases may resolve within one year or slightly more than one year if treatment begins within four weeks after the baby is born. In most Erb’s palsy cases in which treatment begins early in the baby’s life, 100 percent of arm function and feeling is restored.
Erb’s Palsy Treatment Costs
Treating Erb’s palsy may become expensive, especially if a multidisciplinary approach is taken. If Erb’s palsy was caused by birth trauma that was a result of malpractice, parents may be able to seek compensation from the physician or medical facility that helped to cause the injury. A birth injury attorney can help parents to determine whether malpractice was the cause of Erb’s palsy injuries and to understand what steps to take next in order to receive proper compensation and assistance with medical costs.
Sources:
Chater, Michael, Peter Camfield, and Carol Camfield. “Erb’s Palsy – Who Is to Blame and What Will Happen?” Paediatrics and Child Health 9.8 (2004): 556-60. National Center for Biotechnology Information. U.S. National Library of Medicine. Web. 30 Jan. 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724163/>
“Erb’s Palsy.” Brain and Spinal Cord.org. Brain and Spinal Cord.org, 1 Jan. 2014. Web. 30 Jan. 2015. <http://www.brainandspinalcord.org/cerebral-palsy/types/erbs-palsy.html>
“Erb’s Palsy (Brachial Plexus Birth Palsy).” OrthoInfo. Pediatric Orthopaedic Society of North America, 1 Oct. 2014. Web. 30 Jan. 2015. <http://orthoinfo.aaos.org/topic.cfm?topic=A00077>
“Treatment of Erb’s Palsy.” Erb’s Palsy. ErbsPalsy.org, 1 Jan. 2013. Web. 30 Jan. 2015. <http://erbpalsy.org/treatment.html>