Erb's birth palsy: causes, symptoms, diagnosis, treatment

Erb's birth paralysis is named after the German scientist Erb (W. Erb). In 1874, he proved that as a result of obstetric manipulations during childbirth, the shoulder muscles, which are innervated from the 5th and 6th cervical segments of the spinal cord, are affected. As a result, upper paralysis develops.

ICD-10 code

P14.0 Erb's palsy.

What causes Erb's palsy?

Erb's palsy is one of the most common birth injuries of the brachial plexus (diagnosed in 1-2 newborns out of 1000).

The nature of the fetal presentation, large weight (more than 4000 g), difficult, protracted labor with the use of aids (turning onto the leg, application of obstetric forceps, etc.) should alert the pediatrician. In this case, the function of the axillary nerve, which extends from the posterior bundle of the brachial plexus and innervates the posterior portion of the deltoid muscle, the triceps and brachioradialis muscles, the extensors of the wrist and the common extensor of the fingers, is most often affected. The function of the suprascapular nerve, which innervates the supraspinatus muscle, is also affected.

Symptoms of Erb's palsy

A distinction is made between the period of acute paralysis, the recovery period and the period of residual effects.

• The period of acute paralysis lasts from several hours to several days after birth. With paresis, a decrease in active movements of the upper limb is noted: flexion at the elbow joint, raising the shoulder, decreased activity of the fingers. With paralysis, the arm is located along the body, straightened at the elbow joint; active movements are absent in all segments of the affected limb.
• The recovery period lasts up to 2-3 years. At this stage, the edema is absorbed, blood circulation in the damaged tissues is normalized, and active muscle function is restored under the influence of therapeutic measures.
• The recovery period gradually passes into the period of residual paralysis, when the reparative processes in the damaged nervous tissue end. Adduction contracture of the shoulder, its internal rotation and posterior subluxation develop. Hypotrophy of the shoulder joint is expressed. The scapula rotates and its vertebral edge protrudes posteriorly. Flexion contracture forms in the elbow joint, rotational movements of the forearm are impaired. The hand is in a position of palmar or dorsal flexion, the function of the extensors of the fingers and hand suffers.

Treatment of Erb's palsy

Conservative treatment of Erb's paralysis should be carried out by a pediatrician, neurologist and orthopedist from the first days of the child's life. One of the first tasks is to prevent the development of contractures. Using a cotton-gauze wedge splint, the affected limb is placed in the following position: the shoulder is rotated outward to the middle position and abducted by 90°. The forearm is given a supination position of 30° with flexion at the elbow joint to 90°: the hand in dorsal flexion is no more than 20°. After 3 weeks, massage, therapeutic exercises, and physiotherapy measures are started. Drug treatment is also prescribed, aimed at normalizing the functions of the central nervous system, restoring neuromuscular conduction.

Early complex conservative treatment of Erb's paralysis leads to a positive effect in 70% of patients. In the absence of positive dynamics from the therapy, a neurosurgeon consultation is required to decide on neurosurgical recovery.

During the period of residual effects, when the paralytic condition stabilizes and stable contractures and muscle atrophies have already formed, they resort to reconstructive plastic interventions. These measures are carried out in order to create a functionally advantageous position of the limb and, if possible, restore its active functions.