Erb’s Palsy, also known as Erb-Duchenne Palsy, is a type of brachial plexus injury involving damage to the upper nerves of the brachial plexus, most commonly the C5 and C6 nerve roots. These nerves control the movement and sensation of the shoulder, arm, and part of the hand.

The condition most frequently occurs during difficult childbirth when excessive stretching of the baby's neck and shoulder region injures the brachial plexus nerves. In some cases, Erb’s Palsy can also occur following trauma, falls, or accidents in older children and adults.

The affected arm often assumes a characteristic “waiter's tip” posture, where the arm hangs by the side with the shoulder internally rotated, elbow extended, forearm pronated, and wrist flexed.

The severity of Erb’s Palsy varies depending on the extent of nerve damage:

• Neuropraxia: Mild stretching injury with good recovery potential.
• Neuroma: Scar tissue formation affecting nerve function.
• Rupture: Partial or complete tearing of the nerve.
• Avulsion: The nerve is torn from the spinal cord, representing the most severe form.

Many children experience significant improvement with early intervention, while some may require long-term rehabilitation or surgical management. Physiotherapy plays a vital role in promoting nerve healing, maintaining joint mobility, strengthening muscles, and improving functional use of the affected arm.

At Magnum Physiotherapy, we provide comprehensive pediatric rehabilitation programs designed to maximize recovery and support developmental milestones.

Common Symptoms

• Weakness in one arm
• Reduced movement of the shoulder or elbow
• Decreased grip strength
• Arm held close to the body
• Limited shoulder rotation
• Absent or reduced Moro reflex on the affected side
• Muscle stiffness or tightness
• Delayed motor development
• Difficulty reaching or grasping objects
• Differences in arm size or muscle development

Causes & Risk Factors

Birth-Related Factors

• Difficult or prolonged labor
• Shoulder dystocia
• Breech delivery
• Large birth weight (macrosomia)
• Instrument-assisted delivery (forceps or vacuum)

Trauma-Related Causes

• Falls
• Sports injuries
• Motor vehicle accidents

Types of Brachial Plexus Injury

Erb’s Palsy (C5-C6)

Primarily affects shoulder and elbow movement.

Extended Erb’s Palsy (C5-C7)

Involves additional weakness of the wrist and fingers.

Total Brachial Plexus Injury (C5-T1)

Affects the entire arm and hand.

Diagnosis

At Magnum Physiotherapy, we perform a comprehensive assessment to evaluate the extent of nerve involvement and functional limitations.

The evaluation may include:

• Detailed birth and medical history
• Observation of spontaneous arm movements
• Muscle strength assessment
• Joint range of motion testing
• Reflex examination
• Developmental milestone assessment
• Functional movement evaluation
• Review of imaging or nerve studies if available

This thorough assessment allows us to develop an individualized rehabilitation plan.

Treatment at Magnum Physiotherapy

Our rehabilitation approach focuses on maximizing recovery, improving function, and preventing secondary complications.

Pediatric Neurorehabilitation Programs

• Passive Range of Motion Exercises
• Active-Assisted Movement Training
• Muscle Strengthening Programs
• Sensory Stimulation Techniques
• Functional Play Therapy
• Developmental Milestone Training
• Bilateral Arm Activities
• Constraint-Induced Movement Therapy (when appropriate)

Advanced Rehabilitation Approaches

• Electrical Muscle Stimulation (EMS)
• Neuromuscular Re-Education
• Dynamic Neuromuscular Stabilization (DNS)
• Kinesio Taping®
• Positioning and Splinting Strategies
• Parent Education and Home Exercise Programs

Benefits of Physiotherapy for Erb’s Palsy

• Promotes nerve recovery
• Maintains joint mobility
• Prevents muscle tightness and contractures
• Improves muscle strength
• Enhances arm and hand function
• Supports normal motor development
• Improves coordination and movement control
• Encourages independence in daily activities
• Prevents long-term deformities
• Improves overall quality of life

Prognosis

The prognosis depends on the severity of nerve injury:

• Mild nerve injuries often recover within weeks to months.
• Moderate injuries may require prolonged rehabilitation.
• Severe injuries may require surgical intervention and long-term therapy.

Early physiotherapy significantly improves functional outcomes and long-term recovery.

Why Choose Magnum Physiotherapy?

At Magnum Physiotherapy, our pediatric rehabilitation team specializes in evidence-based treatment for brachial plexus injuries and neurological conditions. We work closely with families to provide individualized care, developmental support, and long-term rehabilitation strategies that help children reach their full potential. Our goal is to maximize recovery, improve function, and enhance quality of life for every child.