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Erb’s palsy is a form of brachial plexus injury that can affect a newborn’s shoulder and upper arm. Some children regain substantial movement as the affected nerves recover. Others continue to experience weakness, restricted range of motion, or permanent impairment that may require therapy, medical monitoring, or surgical care.
Parents may first notice that their baby does not move one arm normally or keeps the arm close to the body. In other cases, families may remember a difficult delivery, shoulder dystocia, several delivery maneuvers, or an assisted birth. These circumstances often point to how the delivery was handled, and the labor and delivery records can show what the healthcare team did at each step.
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Erb’s palsy affects nerves in the upper portion of the brachial plexus. The brachial plexus is a network of nerves that extends from the spinal cord through the neck and shoulder into the arm.
These nerves control movement and sensation in portions of the shoulder, arm, forearm, and hand. When the upper nerves are stretched or torn during delivery, often from excessive pulling on the baby’s head and neck, a newborn may experience weakness or paralysis affecting the shoulder and upper arm.
Possible signs may include:
The severity varies considerably.
Some children experience less severe nerve stretching and begin regaining movement during infancy. More significant damage can result in persistent weakness or restricted use of the arm.
Erb’s palsy is one form of neonatal brachial plexus palsy. Not every brachial plexus injury is Erb’s palsy because different nerve roots can be affected and produce different patterns of impairment.
The condition is uncommon but recognized in obstetric and pediatric care. An American College of Obstetricians and Gynecologists task force reported an overall incidence of neonatal brachial plexus palsy, including temporary and persistent cases, of approximately 1.5 per 1,000 births.
A broader review of 63 publications involving more than 17 million births found a similar U.S. rate of about 1.5 cases per 1,000 births.
Erb’s palsy may develop when nerves in the upper brachial plexus are stretched or damaged around the time of delivery.
One circumstance frequently associated with these injuries is shoulder dystocia.
Shoulder dystocia occurs when the baby’s head has been delivered but one shoulder becomes positioned behind the mother’s pelvic bone, making delivery of the body more difficult. Healthcare providers may need to use specific maneuvers to release the shoulder.
Shoulder dystocia is an obstetric emergency that delivery teams are trained to manage with a recognized sequence of maneuvers. When a child develops Erb’s palsy after a difficult delivery, the medical records may be reviewed to determine:
The review can show whether the delivery team followed recognized steps for releasing the shoulder or applied force that stretched the baby’s nerves.
Other factors associated with neonatal brachial plexus palsy may include higher birth weight, maternal diabetes, instrument-assisted delivery, and breech presentation. A systematic review and meta-analysis identified these among the principal risk factors.
Providers are expected to recognize these risk factors before delivery and plan for them, including preparing for a possible shoulder dystocia.
Recovery depends on the severity and location of the nerve damage.
Some children regain substantial or full function as stretched nerves recover. Others continue to experience weakness or limited range of motion.
Medical research shows that a significant share of children are left with lasting impairment. A review of U.S. studies found that neonatal brachial plexus palsy lasted at least 12 months in approximately 10% to 18% of affected children.
A more recent pediatric review reported persistent deficits in approximately 20% to 30% of children with neonatal brachial plexus palsy, reflecting differences among patient populations and study methods.
Factors affecting recovery may include:
Treatment may include:
The child’s medical team may monitor progress over several months before the full extent of the injury becomes clear.
Erb’s palsy can support a medical malpractice claim when the evidence shows that a healthcare provider failed to meet the accepted standard of care and that this failure caused or contributed to the nerve injury.
Questions may include whether providers:
Causation can be particularly important in these cases. The delivery notes, the sequence of maneuvers, the amount of traction used, and nerve testing after birth can work together to show how the delivery team’s handling of the birth injured the baby’s nerves.
A child with lasting Erb’s palsy may have difficulty with movements that require full strength or range of motion in the affected arm.
Depending on the severity, long-term concerns can include:
The effects can change as a child grows.
A limitation that appears relatively minor during infancy may become more noticeable when the child begins dressing independently, participating in school activities, playing sports, or performing tasks requiring coordinated use of both arms.
A serious medical malpractice case may therefore require evaluation of future needs rather than focusing only on initial treatment.
Potential future costs may involve:
When permanent functional loss is present, the analysis may also consider how the injury could affect future employment and independence.
Arizona law places time limits on medical malpractice actions.
Under A.R.S. § 12-542, claims for injuries to another person, including causes of action for medical malpractice, generally must be commenced within two years after the cause of action accrues.
Claims involving children can require additional legal analysis under other Arizona provisions. Parents may also have claims separate from those belonging to the child.
Families should therefore obtain guidance based on their individual circumstances rather than assume that every claim related to the same delivery follows one deadline.
Earlier review may also help preserve delivery records, document what parents remember, and follow the child’s medical progress as treatment continues.
If your child developed Erb’s palsy after a difficult delivery in Mesa, Snyder & Wenner can review the medical evidence and explain whether further investigation may be appropriate.
Erb’s palsy is a type of brachial plexus injury affecting nerves that help control the shoulder and upper arm. A newborn may have weakness, reduced movement, or paralysis in the affected limb.
Erb’s palsy is one form of brachial plexus injury. It typically affects the upper portion of the nerve network, while other brachial plexus injuries may involve different nerves and affect more of the arm or hand.
Possible signs include limited movement of one arm, shoulder weakness, difficulty bending the elbow, reduced reflexes, or an arm that remains positioned close to the body.
Shoulder dystocia occurs when the baby’s head is delivered but one shoulder becomes lodged behind the mother’s pelvic bone. Healthcare providers may need to use specific maneuvers to complete delivery.
Shoulder dystocia is closely linked to Erb’s palsy. When the baby’s shoulder is caught behind the pelvic bone, excessive pulling on the head or poorly performed maneuvers can stretch the upper nerves of the brachial plexus. Erb’s palsy can also follow other difficult deliveries, including those involving forceps or vacuum extraction.
Erb’s palsy can involve medical negligence when providers fail to meet the applicable standard of care and that conduct causes or contributes to the nerve injury. Examples can include pulling or twisting the baby’s head to free the shoulder, failing to call for additional help during a shoulder dystocia, or failing to plan for a high-risk delivery when a large estimated fetal weight or maternal diabetes was known.
Some children regain substantial or full function, particularly when the nerve injury is less severe. Others experience lasting weakness or restricted movement. Recovery depends on the nerves affected and the extent of the damage.
Yes. Some children regain substantial or full movement as the affected nerves recover. Others continue to experience weakness or limited mobility. Prognosis depends on the location and severity of the nerve damage.
Treatment may include physical therapy, occupational therapy, range-of-motion exercises, neurological or orthopedic monitoring, diagnostic testing, and surgical evaluation when significant impairment persists.
Our attorneys review the pregnancy and delivery records, including the circumstances surrounding any difficult delivery or shoulder dystocia. When appropriate, we work with qualified medical professionals to evaluate the standard of care, causation, and long-term consequences before determining whether further legal action may be appropriate.