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Erb’s Palsy

Erb’s palsy is one of the most common types of birth injury, affecting one or two children out of every 1,000 births. It is caused by damage to the brachial plexus (five nerves that connect the spine to the arms and hands). Also known as Erb-Duchenne paralysis, this condition causes muscle weakness, loss of function and sometimes causes sensory issues. 

Although many cases of Erb’s palsy resolve on their own over time, serious cases require significant treatment and potentially surgery. Sometimes the loss of function, which may include partial or complete paralysis of the limbs, is permanent.

Erb’s palsy can occur naturally depending on how the fetus is positioned in the womb during pregnancy or labour. However, the manner in which a medical provider handles the baby during birth can also cause this injury. If a doctor, midwife, or other medical provider has been negligent in their care of the mother or child during pregnancy or labour, they may be liable for the damages and losses caused by the medical negligence.

If your child has been diagnosed with Erb’s palsy, or if you are concerned that they may have sustained a birth injury, a medical malpractice lawyer may be able to help you obtain compensation.

Bracchial plexus injuries.

How does Erb’s palsy occur?

The brachial plexus is a complex network of five nerve branches that connect a person’s spine to their arms. Consisting of five major nerves (musculocutaneous nerve, axillary nerve, median nerve, radial nerve, and ulnar nerve), the brachial plexus acts as a communication channel through which the brain sends and receives messages to the shoulders, arms, hands and fingers. Each nerve affects a different part of the arm and controls aspects of movement ranging from lifting and rotation to finer motor skills. The nerves also send sensory messages.

Although a brachial plexus injury can occur at any time in a person’s life, they are most common during pregnancy and especially during labour if a child needs to be pulled from the birth canal. If the person delivering the baby must move the baby’s head during delivery or use force to pull it during a vaginal birth, the brachial plexus nerves may be damaged.

Common types of brachial plexus injuries that may cause Erb’s palsy risk factors include:

  • Neurapraxia (a stretched nerve).
  • Rupture (a torn nerve that remains connected to the spine).
  • Avulsion (a nerve torn from the spine).
  • Neuroma (scar tissue that forms following a tear that prevents nerve signals).

Avulsion is the most serious type of Erb’s palsy and cannot be fully repaired. Neurapraxias are the most common form of injury. While many of these stretches resolve on their own, others require physical therapy or other treatments, including surgery.

What are the symptoms of Erb’s palsy?

Depending on the nerve(s) affected, the type of nerve injury, and the extent of the damage, a person with Erb’s palsy may experience:

  • Paralysis of all or part of the shoulder, arm or hand.
  • Limpness or weakness of the shoulder, arm or hand.
  • Numbness or a burning sensation in the arm or hand.
  • A hand position called “waiter’s tip” where fingers curl up and the palm of the hand points toward the back.

Your family doctor or pediatrician may diagnose a brachial plexus injury based on a physical examination. Imaging diagnostics such as x-rays, magnetic resonance imaging (MRIs), computed tomography (CT) scans, dye tests, and ultrasounds can identify if the nerve injury has affected any other surrounding body parts such as the shoulder or neck. Other tests, including nerve conduction studies and electromyograms, can help determine how well arm muscles work and the extent of the nerve damage.

How is Erb’s palsy treated?

Treatment for Erb’s palsy varies according to the severity of the injury and how well the nerves and muscles respond to different interventions. Early treatment can often lead to better outcomes. If there is no improvement after three to six months, surgical interventions are usually recommended.

Some available treatments include:

  • Physical therapy - non-surgical interventions such as physical therapy are usually the first line of treatment. At about three weeks of age, daily physical therapy can begin on your baby. Certain exercises will help to maintain the arm’s range of motion and prevent joints from becoming permanently stiff (joint contracture). These exercises should be done as often as possible for maximum benefit. Many brachial plexus injuries resolve on their own and with the help of physical therapy, but recovery is often very slow. If possible, a full recovery may take up to two years.
  • Other non-surgical treatments - certain medications injected into certain muscles can be used to temporarily paralyse them in order to encourage surrounding weaker muscles to become more active. Splints can also be used to counter “waiter’s tip”.
  • Microsurgery - nerve graft or nerve transfer surgeries can be performed on younger infants to improve, but not usually fully restore, function. Using specialized surgical instruments, a microsurgeon can sometimes splice a nerve graft from the child or fully transfer a nerve from another muscle. Nerve growth is very slow and the success of the surgery may not be known for months or years. Intensive rehabilitation therapy is also required.
  • Other surgical procedures - to treat joint contractures, sometimes surgery will be performed to remove thickened tissue around joints in the arm. Sometimes tendons can also be transferred from another part of the body to improve arm function.

Learning that your newborn is beginning life with an injury is a terrible discovery. Thinking that another person’s negligence may have caused or contributed to that injury can weigh heavily on your mind. You may be feeling sad, angry, worried and/or overwhelmed by this news. But you should not feel alone.

Our Erb’s palsy malpractice lawyers have helped many new parents as they explored their child’s diagnosis and considered their legal options. Our knowledgeable, experienced and skill team includes staff who have personally experienced a loved one’s birth injury journey and understand the many emotions you may be feeling. You can trust us to treat you and your family with the respect, kindness and compassion you deserve.

When you contact our office for a no cost, no obligation consultation, we will listen as you explain what has happened, what concerns you have, and what questions remain unanswered. We will give you all the time you need to feel comfortable as we explain your rights and various options.

If you decide to pursue a civil claim against a medical provider whose malpractice caused or contributed to your child’s injury, we will outline all the steps necessary for you to receive compensation and damages. Medical malpractice cases can be expensive to pursue, but if Gluckstein Personal Injury Lawyers represents you in the matter, you will never have to pay out of pocket for costs. By working on contingency, our firm only gets paid if we are successful in court or negotiate a settlement.

Gluckstein Lawyers commitment to full-circle care.

Pursuing a birth injury claim is part of a journey of healing you and your loved ones are beginning. Choosing who you want to join you on this journey is an important decision. Gluckstein’s Erb’s palsy birth injury team is not only highly regarded for our skill by our peers in the legal sector, but also renowned for our commitment to full-circle client care. We treat our clients as if they are family. That means we will be here for you whenever you need us, and interested in your life and pursuit of happiness beyond the time spent on a lawsuit.

During one of the most difficult and trying times in your life, trust Gluckstein Personal Injury Lawyers to be your fierce advocate for justice and compassionate supporter for your well-being.

Ontario Erb’s Palsy Birth Injury Lawyers.



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