Understanding the impact of Erb’s Palsy

Erb’s Palsy is a form of obstetric brachial plexus disorder, caused by damage to the nerves of the shoulder during birth. It is estimated that between one and two babies out of every 1,000 will be born with Erb’s Palsy.

There are five primary nerves that supply movement and feeling to an arm. During a difficult birth, it is possible for one or more of these to be stretched or, in the worst-case scenarios, torn during birth, which then affects the growth and mobility of the affected arm following birth.

For some, the damage will be minor, and will completely heal either on its own or with some physiotherapy work. For others, the damage can be so severe that they are left with a life-long disability, limiting the function of their arm and compromising their daily lives.

The extent of the damage done to these nerves will be dependent on the amount of force placed on the baby’s shoulder during birth and how long the stretching lasts. If the stretching is minimal and brief, the baby could only suffer neuropraxia, a mild form of nerve injury where the nerves do not tear, meaning they are likely to heal over time.

However, if the pressure on the shoulder is more severe for a longer period of time, it could cause the nerves to tear and rupture. Depending on the severity, this can significantly limit the movement of the baby’s arm for the rest of their life, as well as impact its potential to grow.

The overwhelming cause of Erb’s Palsy is a difficult or rushed birth. If a midwife or obstetrician has concerns about how quickly a birth needs to occur, for instance, if there is evidence the baby is suffering from oxygen deprivation, there is greater pressure on all involved.

This can lead to a birth injury called shoulder dystocia. This is where one or both of the baby’s shoulders become stuck, typically against the mother’s hard pelvic bone. When the midwife or obstetrician is trying to deliver the baby quickly, pulling a baby in this situation against the resistance of the pelvic bone can strain and tear the brachial plexus.

There are a number of accepted manoeuvres and actions that healthcare providers are trained to employ in these situations in order to help free the baby’s shoulder from this predicament. However, if they are applied too late, incorrectly or are ignored altogether, it can cause serious damage to the baby’s shoulder, which can then lead to them suffering Erb’s Palsy.

Another potential cause of Erb’s Palsy is excessive pressure being placed on the baby’s raised arms during a breech delivery (i.e. feet-first). Again, midwives or obstetricians in these scenarios are expected to take care of manoeuvring both mother and child to best relieve the pressure on the baby’s shoulder.

While Erb’s Palsy can occur during any birth, there are a number of factors that increase the risk of this possibility:

• The infant being untypically large or having a high birth weight
• The mother’s pelvis being abnormal or overly small
• Maternal diabetes
• Excessive maternal weight gain prior to the birth
• Use of birth assisted tools, such as forceps or ventouse
• The second stage of labour lasting over an hour
• If the mother has given birth to another child that suffered shoulder dystocia

It is therefore crucial that healthcare professionals accurately screen mothers prior to delivery and complete an accurate medical history, which is then noted by the midwives and obstetricians responsible for managing the birth. This ensures that, where necessary, a Caesarean section can be arranged to prevent this birth injury from occurring.

The extent of the injury with Erb’s Palsy is very wide, and each situation is unique. Some will have a transient weakness of the arm, elbow or shoulder, which may heal on its own over time or through physiotherapy.

Others might endure restricted growth and some loss of function. Unfortunately, those at the furthest end of the spectrum could be completely unable to use their arm or hand, which carries significant lifelong implications.

It also depends on which arm is damaged in relation to the individual’s preferred hand – something that is decided at birth. If their dominant hand is the one affected by Erb’s Palsy, the impact on their life can be even more substantial, as they have to learn to function with their weaker hand.

First, there is the cost of ongoing physiotherapy to consider, in order to manage the movement of the person’s joints and best look after the health of the affected arm. There might also be the possibility of surgery to attempt to repair the damaged joints.

This is heightened by any expenses that are required to modify the baby’s accommodation or surroundings to minimise the impact of their disability and improve their quality of life, such as voice-activated technologies and other specialist equipment.

If their condition will remain across their life, these adaptations and equipment needs will only grow in order to help them live as independent a life as possible. Think of everything that you do on a daily basis that requires two hands:

• Opening tins and packages
• Driving a car
• Lifting heavy objects
• Bathing and dressing

Consequently, this also places a burden on the affected individual’s loved ones, who will likely need to assist their child with these tasks. This may impact their ability to earn money as they are required to look after their child, as well as their overall quality of life. Alternatively, there would be the cost of hiring carers to take care of their children while they are at work.

Finally, while we cannot ignore the physical impact that Erb’s Palsy can have on an individual, it also can cause the affected individual a lot of emotional trauma as well. The need for additional assistance at school or abnormal growth of their arm could alienate them from their peers, as well as restrict their independence.

Plus, they will likely miss out on a number of pivotal childhood events and pastimes that many of us take for granted, such as riding a bicycle, swimming or playing sports and other outdoor games. While schools should make every effort to be inclusive of those with Erb’s Palsy, the experience can be an emotional and psychological struggle for those affected.