Which are the symptoms of Erb's Palsy?

Erb's Palsy is a brachial plexus birth injury characterized by weakness or paralysis of the arm, often presenting as a "waiter's tip" position where the arm hangs limp and rotated inward. Symptoms result from damage to the upper nerves of the brachial plexus, typically occurring during a difficult delivery, and range from temporary nerve stretching to permanent nerve rupture.

What are the primary symptoms of Erb's Palsy?

The most characteristic sign of Erb's Palsy is a lack of movement in the affected arm immediately following birth. Because the injury involves the C5 and C6 nerves, the infant often exhibits the following clinical presentation:

• Arm held against the body with the elbow extended and the wrist flexed (the "waiter’s tip" posture).


• Absent Moro (startle) reflex on the affected side.


• Decreased grip strength or inability to grasp objects as the child grows.


• Muscle atrophy or shortening of the limb if the injury is severe.


• Sensory loss or numbness in the shoulder, arm, or hand.

How does symptom severity vary in patients?

The severity of Erb's Palsy depends on the degree of nerve damage. In cases of neuropraxia (a temporary stretch), symptoms may resolve spontaneously within a few months. However, in more severe instances like neurotmesis (a complete nerve rupture), permanent impairment is common. Symptoms of Erb's Palsy can significantly impact quality of life by limiting reach, fine motor skills, and athletic participation, often requiring long-term physical or occupational therapy.

How do symptoms change or progress over time?

While many infants show improvement within the first 6 to 12 months, some children with Erb's Palsy may develop secondary complications as they grow. These can include joint contractures, where muscles become permanently tightened, or bone deformities in the shoulder and elbow. Monitoring by a pediatric specialist is essential, as early signs of these secondary issues can often be managed with aggressive physical therapy or, in some cases, reconstructive surgery.

When should families seek immediate medical attention?

Parents should consult a specialist if they observe a lack of progress in motor function after the first few months of life or if they notice the child favoring one arm over the other. Immediate evaluation is also necessary if the child develops a sudden increase in pain or a visible change in the shape of the shoulder joint, which could indicate a dislocation related to Erb's Palsy.

Next steps

• Consult a pediatric neurologist or an orthopedic surgeon specializing in brachial plexus injuries.


• Begin a consistent physical therapy regimen to maintain range of motion.


• Join the DiseaseMaps.org community to connect with others sharing their experiences with Erb's Palsy.


• Keep a detailed log of your child's developmental milestones to share with your medical team.

Medical disclaimer: This content is for informational purposes only and does not constitute professional medical advice, diagnosis, or treatment; always seek the advice of your physician regarding a medical condition.

References

• NIH Genetic and Rare Diseases (GARD) Information Center: Erb's Palsy.


• Orphanet: Brachial plexus birth palsy.


• MedlinePlus (U.S. National Library of Medicine): Brachial plexus injury.


• Brachial Plexus Injury Foundation: Understanding nerve recovery.