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Understanding Erb’s Palsy | Wollens Solicitors Devon

Causes, Risk Factors and Diagnosis

Erb’s palsy is a birth injury caused by damage to the brachial plexus, a network of nerves that controls movement and sensation in the shoulder, arm and hand. It most commonly affects the C5 and C6 nerve roots and can range from a temporary weakness to a permanent disability affecting the use of the arm. Erb’s palsy is the most common form of obstetric brachial plexus injury.

What Causes Erb’s Palsy?

Erb’s palsy most often occurs during a difficult delivery when the baby’s shoulder becomes lodged behind the mother’s pubic bone after the head has been delivered, a complication known as shoulder dystocia. During attempts to deliver the baby, the nerves of the brachial plexus can become damaged.

The severity of the injury will determine the child’s symptoms and long-term outlook. Some babies recover fully within weeks or months, while others are left with lasting weakness, reduced range of movement or impairment requiring surgery and ongoing therapy

Risk Factors for Erb’s Palsy

Although Erb’s palsy can occur unexpectedly, several recognised factors can increase the risk of a brachial plexus injury during birth.

Shoulder Dystocia

Shoulder dystocia is the most significant risk factor. It is an obstetric emergency that requires prompt and appropriate management to safely deliver the baby whilst minimising the risk of injury.

Larger Babies (Macrosomia)

Babies who are expected to have a higher birth weight may have an increased risk of shoulder dystocia, which in turn increases the risk of brachial plexus injury.

Maternal Diabetes

Maternal diabetes can be associated with larger babies and therefore an increased risk of delivery complications, including shoulder dystocia.

Prolonged or Difficult Labour

Long or obstructed labours can increase the likelihood of complications during delivery and may necessitate interventions that carry additional risks.

Previous Shoulder Dystocia

A history of shoulder dystocia in a previous pregnancy may increase the risk of recurrence and requires careful consideration when planning future deliveries.

Signs and Symptoms

The signs of Erb’s palsy are usually apparent shortly after birth. These may include:

Weakness or paralysis of one arm.
Reduced movement in the shoulder, arm or elbow.
An arm that hangs by the child’s side.
Difficulty bending the elbow or lifting the arm.
Reduced grip strength in more severe injuries.

How is Erb’s Palsy Diagnosed?

Diagnosis is usually based on a clinical examination shortly after birth. Healthcare professionals will assess the baby’s movement, muscle strength and reflexes. In some cases, imaging scans or nerve studies may be required to determine the extent of the injury and to assist with treatment planning.

Can Erb’s Palsy Be Prevented?

Not every case of Erb’s palsy is preventable, and the condition can occur even where appropriate obstetric care has been provided. However, careful identification of risk factors during pregnancy, appropriate birth planning, and effective management of shoulder dystocia are important in reducing the risk of injury.

How Wollens Can Help

For many families, one of the most difficult aspects following a diagnosis of Erb’s palsy is understanding whether anything could have been done differently during labour and delivery. While not every case results from negligent care, concerns may arise where risk factors were not recognised, labour was not appropriately managed, or established obstetric procedures were not followed.

Wollens’ Clinical Negligence team can investigate your child’s birth, gather expert evidence, and advise if you have grounds for a clinical negligence claim.

If your child has been diagnosed with Erb’s palsy and you have concerns about the care provided during pregnancy, labour or delivery, contact Wollens’ Clinical Negligence team for an initial discussion. We can help you understand what happened, answer your questions and advise on the options available to you and your family.