Erbs Palsy - Queensland Medical Rights Solicitors QLD

SOLICITORS HELPLINE 07 3613 7325


If you think that you or your child have received inadequate or negligent medical treatment resulting in Erbs palsy, our solicitors will be able to assist you in making a complaint to the Office of the Health Ombudsman (OHO) in Queensland. Our QLD based solicitors deal with health care complaints on a ‘pro bono’ basis and will not make any charge to you for advice on how to make a complaint to the Office of the Health Ombudsman. A complaint to the Office of the Health Ombudsman in QLD is not a medical negligence compensation claim and will not result in the payment of compensation but may assist you in further understanding what went wrong and why you were treated in the way that has caused you concern. There are a number of possible outcomes and the Queensland Office of the Health Ombudsman may be able to obtain a more full explanation of the circumstances of any alleged negligence or may give you more details about the treatment that you have received.

Erb’s Palsy

Erb’s palsy is also called Erb-Duchenne palsy or brachial plexus injury. It is a congenital injury involving the upper extremity of a newborn infant. The paralysis is caused by damage to the upper group of the main nerves of the arm near the neck and shoulder, particularly the C5 and C6 nerves, which form a part of the brachial plexus. The entire brachial plexus involves nerves exiting from C5 through C8 and the T1 nerve.

The main cause of Erb’s palsy is the pulling on of the shoulder at the time of a difficult birth in which the infant has shoulder dystocia. This means the shoulders are stuck in the birth canal because the baby is too big or the vaginal exit is too small. Fortunately, some cases of brachial plexus injuries resolve on their own over several months. Others require rehabilitation to resolve and still others require surgery. Some cases do not resolve on their own and the patient has permanent paralysis of the upper extremity.

The syndrome of brachial plexus injury was first described by a British obstetrician, William Smellie, in 1768. He reported on a case in which a baby developed paralysis following a difficult birth. Later, in 1861, Guillaume Benjamin Amand Duchenne called the disease “obstetrical palsy of the brachial plexus” after looking after four children who had identical injuries due to obstetrical trauma. The cases were first published in 1855. In 1874, Wilhelm Heinrich Erb determined that the palsies involved the deltoid, biceps and subscapularis muscles and that C5 and C6 nerve roots were involved rather than peripheral nerves.

Erb’s palsy is the result of pulling the head of the infant too far to the side when attempting to extract the infant. The pulling laterally of the head is an attempt to get stuck shoulders out of the birth canal. It is a condition that only happens in a cephalic or head down position and, when the shoulders get stuck, the obstetrician naturally pulls on the head to one side. Unfortunately, pulling too much can sever or stretch the nerve roots in the brachial plexus.

In some cases, such as in a feet first breech presentation, the neck can be pulled too much in an attempt to get out the head and there can be brachial plexus injury with paralysis in the infant. Infants who sustain a clavicle fracture even if it is unrelated to a difficult birth can get a brachial plexus injury. A person of any age can get a brachial plexus injury following head and shoulder trauma that stretch the brachial plexus. Gunshot wounds, traction on the arm and attempts to lessen dislocation of the shoulder joint are all possible causes of brachial plexus injury. In such cases, the degree of injury depends on how much of the brachial plexus is involved.

The paralysis of the muscle may be complete or partial. The nerve supplying the muscle can simply be bruised or it can be stretched or torn. C5 is the nerve root that is primarily affected as well as the union of C5 to C 6 in the brachial plexus. This point is called Erb’s point and is mostly involved because it is furthest from the force of the traction and is the first spot affected. The nerves most commonly affected include the musculocutaneous nerve, the suprascapular nerve and the axillary nerve.

Signs and symptoms of a case of Erb’s palsy include a paralysis and atrophy of the deltoid, biceps and brachialis muscle along with loss of sensation in those areas. The arm is usually hung down by the side of the body and is rotated medially. The forearm is usually extended and pronated in a position known as the “waiter’s tip” position. The patient who gets this as an infant will usually have stunted growth of the affected arm from the shoulder to the finger tips. Circulatory impairment is also a problem because the area is denervated. The arm is naturally weaker than the other arm with deficits in large and small motor movements. Over time there is a contracture of the elbow that develops.

The arm cannot regulate its own temperature so it can get too cold in the winter and too hot in the summer without the individual knowing it. The skin cannot heal very well from an injury so skin cuts and abrasions take longer to heal than with normal skin. There is a greater likelihood of getting infections in the skin when the skin is broken. This is a bigger problem in kids than it is in adults. The loss of sensation is worse between the shoulder and elbow because this is the area most affected by the nerve injury.

The arm’s appearance differs depending on the person. In some cases the arm may be unable to straighten or rotate so that it looks stiff and crooked. Other patients have a lack of control of the arm and the muscles are more flaccid and loose. Some of the appearance of the arm can be made more normal by having early and often physiotherapy including electrical stimulation and massage any time the arm begins to be abnormal appearing again.

There can be a severe cramping pain as part of the condition. It often occurs when the patient has slept on the shoulder or if one uses the arm too much. It can run from the shoulder to the wrist and can be so severe that the patient faints or vomits from the pain. This usually happens when the arm is almost grown and, when it grows completely, the pain lessens. They can also get stiffness and strained muscles from overuse. Some patients have a great deal of pain with their Erb’s palsy and others have no pain at all. Shoulder blade pain is another common phenomenon in people who have Erb’s palsy.

As for treatment, some infants recover spontaneously and others need a surgeon who can operate on their nerves and reattach them. If the nerve is avulsed or fractured, it must be repaired surgically because these can heal gradually over time and function can return to the arm. Physical therapy is necessary to get rid of the muscle atrophy and to use the muscles again. If a child has not regained function within a year, there will likely be some loss of function and disability. Arthritis can happen when the arm is not moved the way it should move.

Nerve transplants can be done and a baby can have a subscapularis release along with a latissimus dorsi tendon transfer to regain some functionality of the arm.

HELPLINE 07 3613 7325