Brachial Plexus Birth Palsy (BPBP) is an injury that happens at birth, causing arm paralysis. These injuries happen in about two out of every 1,000 births. BPBP can involve all the nerves that control the arm and hand. It most often affects the nerves that control part of the shoulder, part of the elbow and part of the wrist.
Erb’s Palsy is a type of BPBP that just affects the first two nerves of the brachial plexus. It affects an infant’s ability to lift the shoulder and flex the elbow.
Early treatment often involves home and supervised therapy to keep all of the child’s joints mobile in order to prevent stiffness while the nerves are healing. In some cases, the injury is severe enough that the nerves are not able to heal sufficiently, or at all.
In those cases, surgery to reconstruct the brachial plexus and repair the damaged nerves may be needed. This is done no later than 9 months of age. More nerve surgery can be accomplished up to age 1.
Treatments may include:
- Nerve repair and grafting
- Nerve transfer
- Tendon transfer
Most children will not require early nerve surgery. For these cases, their progress will be monitored for rare complications, such as painless shoulder dislocation. By age 2, a child has likely reached the limit of natural recovery.
A combination of therapy and even surgery can be used to improve function for older children with weakness or stiffness.