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Erb’s palsy is a form of brachial plexus injury that can affect a newborn’s shoulder, upper arm, and ability to bend the elbow. Some children recover substantial function as the affected nerves heal. Others continue to experience weakness, restricted movement, or permanent impairment that may require therapy, medical monitoring, or additional treatment.
Parents may first notice that their baby is not moving one arm normally or that one arm rests in an unusual position. In other cases, families may remember a difficult delivery, shoulder dystocia, several delivery maneuvers, or an assisted birth. These circumstances may raise important questions about the delivery process, provider decisions, and whether appropriate care was provided when complications developed.
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Erb’s palsy affects the upper portion of the brachial plexus, a network of nerves that extends from the spinal cord through the neck and shoulder into the arm.
These nerves control important movements in the shoulder and upper arm. When they are stretched or otherwise damaged around birth, a newborn may experience weakness or paralysis affecting the involved limb.
Possible signs can include:
The severity varies considerably.
Some children have less severe nerve stretching and improve during infancy. Other injuries involve more significant nerve damage and may result in persistent functional limitations.
Erb’s palsy is one type of neonatal brachial plexus palsy. Not every brachial plexus injury is Erb’s palsy because different nerve roots may be involved and can produce different patterns of weakness.
The condition is uncommon but recognized in obstetric and pediatric care. A major review indexed by the National Library of Medicine reported an overall incidence of neonatal brachial plexus palsy of approximately 1.5 cases per 1,000 births.
Erb’s palsy can occur when the upper brachial plexus nerves 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 of the shoulders becomes positioned behind the mother’s pelvic bone. The healthcare team may need to use specific maneuvers to release the shoulder and complete the delivery.
When shoulder dystocia occurs, the medical review may examine how quickly the condition was recognized, what delivery maneuvers were used, and how healthcare providers responded.
When a child develops Erb’s palsy following a difficult delivery, however, the records may be reviewed to determine:
The purpose of the investigation is to understand how the delivery progressed, what actions were taken, and whether provider decisions contributed to the child’s nerve injury.
Brachial plexus injuries can also occur without documented shoulder dystocia.
Medical literature has identified other associated factors, including higher birth weight, breech presentation, maternal diabetes, and some instrument-assisted deliveries. These factors may provide important context when reviewing the pregnancy, delivery planning, and circumstances surrounding the injury.
Shoulder dystocia is often associated with brachial plexus injuries because resolving the obstruction can place the nerves of the neck and shoulder under stress.
Because each delivery involves different circumstances, evaluating the complete medical record is important when reviewing a potential Erb’s palsy claim.
Erb’s palsy may occur in different delivery circumstances, which is why reviewing the complete timeline of care is important.
Medical literature has repeatedly shown that neonatal brachial plexus palsy can occur in different delivery circumstances. This is why an individual case must be evaluated using the complete medical record rather than one risk factor.
When shoulder dystocia is documented, the review may consider:
The central legal question is whether healthcare providers acted reasonably under the circumstances and whether any departure from the accepted standard caused or contributed to the injury.
Erb’s palsy generally affects the upper portion of the brachial plexus.
Because those nerves contribute to shoulder and elbow movement, affected children may have difficulty lifting or rotating the arm or bending the elbow.
Other brachial plexus injuries can involve additional nerve roots and may affect the forearm, wrist, hand, or entire arm.
The distinction matters because the location and severity of nerve damage can affect:
Medical evaluation may involve repeated physical examinations, imaging, nerve studies, and monitoring of how function returns over time.
For a legal investigation, identifying which nerves are damaged may also help clarify how the injury occurred.
Recovery depends on the severity of the nerve damage.
Some children regain substantial movement and strength during infancy as stretched nerves heal. Others continue to have weakness or limited range of motion.
A systematic review of neonatal brachial plexus palsy literature found that a portion of affected children continued to have impairment beyond the first year of life, illustrating why long-term follow-up can be important.
Factors that may affect recovery include:
Treatment may include:
The treatment plan depends on the child’s specific condition.
An Erb’s palsy claim requires careful review of the delivery records, provider decisions, and evidence surrounding the child’s nerve injury.
A medical malpractice claim generally requires evidence that a healthcare provider failed to meet the accepted standard of care and that this failure caused or contributed to the child’s injury.
Potential questions may include whether providers:
Causation remains essential.
The medical review focuses on identifying how the nerve injury occurred and whether provider actions during delivery contributed to the damage.
Arizona law establishes time limits for medical malpractice actions.
Under A.R.S. § 12-542, medical malpractice actions generally must be commenced within two years after the cause of action accrues.
Cases involving children can require additional legal analysis because Arizona law contains provisions addressing minority and certain filing periods. Parents may also have claims that are legally distinct from those belonging to the child.
Because deadlines can vary depending on the circumstances of the claim, families should seek legal guidance promptly.
Earlier review may also help preserve delivery records and document the child’s medical progress while treatment continues.
If your child developed Erb’s palsy after a difficult delivery in Scottsdale, Snyder & Wenner can review the medical records and review the medical records, evaluate the circumstances surrounding the delivery, and help families understand their legal options.
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 arm.
Erb’s palsy is one form of brachial plexus injury. It generally affects the upper nerves of the brachial plexus, while other injuries can involve different parts of the nerve network.
Possible signs include limited movement in one arm, weakness in the shoulder, difficulty bending the elbow, reduced reflexes, or an arm that remains close to the body.
When shoulder dystocia occurs, medical records can help show when the complication was recognized, what delivery maneuvers were performed, how providers responded, and how the child’s condition was evaluated after birth.
Evidence may include prenatal records, labor and delivery documentation, shoulder dystocia records, delivery notes, newborn examinations, neurological evaluations, imaging, nerve testing, and therapy records.
Relevant evidence may include prenatal records, fetal-size estimates, labor and delivery notes, shoulder dystocia documentation, descriptions of delivery maneuvers, newborn examinations, neurological evaluations, imaging, nerve testing, and therapy records.
Some children regain substantial or full function as the nerves recover. Others continue to experience weakness or limited range of motion. Recovery depends on which nerves were affected and the extent of the damage.
Treatment may include physical therapy, occupational therapy, range-of-motion exercises, neurological or orthopedic monitoring, imaging, nerve studies, and surgical evaluation when significant impairment persists.
Persistent weakness may indicate a more significant nerve injury. Medical evaluation can help determine the degree of permanent impairment and whether additional treatment or rehabilitation may be appropriate.
Our attorneys review the pregnancy and delivery records, including the circumstances surrounding any shoulder dystocia or difficult birth. When appropriate, we work with qualified medical professionals to evaluate the standard of care, causation, and long-term consequences to evaluate the medical evidence and help families understand the legal options available.