Erb’s Palsy

Also known as: Erb–Duchenne Palsy


Erb’s palsy describes a paralysis of the nerves supplying the arm, mainly occurring after trauma during birth. The incidence of Erb’s palsy is now established at 1 in 2,000 live births.

There are five big nerves which constitute the brachial plexus, a network of nerves that begin at the spinal cord in the neck controlling the hand, wrist, elbow, and shoulder. Each of these nerves has specific functions:

  • C5 shoulder movement (in particular, the ability to lift the arm sideways)
  • C6 elbow flexion (being able to bend the elbow)
  • C7 wrist extension
  • C8 T1 hand function.


Medical text written November 1992 by Professor R Birch, Consultant Orthopaedic Surgeon, Royal National Orthopaedic Hospital, Stanmore, UK. Last updated November 2011 by Mr Marco Sinisi, Consultant Nerve Surgeon, Royal National Orthopaedic Hospital, Stanmore, UK.

What are the symptoms?

Depending on which nerves have been mainly affected children with Erb’s Palsy are divided in four groups. As well as grouping the symptoms experienced, the grouping relates to prognosis (1 being the most favourable and 4 the worst).

Group 1 − children have paralysis of the shoulder and elbow, involving the 5th and 6th (C5 and C6) cervical nerves. This results in the arm being turned towards the body, the elbow unable to bend and the hand being in the ‘waiters tip’ position.

Group 2 − have the same presentation as group 1, but with lack of wrist extension too due to the involvement of C7 as well.

Group 3 − all the nerves are affected and therefore the child has got a complete paralysis of the upper limb.

Group 4 − the entire arm is paralysed and there is demonstrable sensory loss. Horner syndrome is present, which is characterised by drooping of the eyelid, a cheek that does not sweat and a smaller pupil on the affected side of the face. Torticollis, a twisted neck in which the head is tipped to one side while the chin is turned to the other, may also present.

Very infrequently there is Klumpke’s paralysis – which involves the 7th and 8th cervical (C7, C8) and 1st thoracic (TH1) nerves. The result is a flaccid (floppy) paralysis of the hand that is often associated with Horner syndrome.

What are the causes?

Erb’s palsy is mainly caused by birth trauma when traction (straightening) of the head or arm, or twisting the arm or shoulder down and backward, results in paralysis of the nerves supplying the arm.

How is it treated?

It is now possible to say that over half of children born with Erb’s palsy make a complete recovery. Of the remaining cases, another 30 to 35 per cent make very useful recovery as relates to nerve injuries. Properly conducted neurophysiological investigations are most helpful in determining the likelihood of recovery and do help in deciding which children will be likely to benefit of surgical intervention.

Urgent operations can be restricted to a relatively small number of children who have complete and severe injuries or those who have suffered major injury to the plexus from breech delivery (delivery of the baby feet first rather than head first). However, between 25 to 35 per cent of the children face difficulties due to contracture (tightening of the joint) at the shoulder leading to posterior dislocation of that joint, meaning that the bones become misaligned in the joint. The treatment of these deformities can improve the growth of the shoulder joint leading also to increased function of the affected limb.

Is there support?

Erb’s Palsy Group

Tel: 024 7641 3293
Email: [email protected]

The Group is a Registered Charity in England and Wales No. 1036423. It provides information and support for families affected by Erb’s Palsy. The Group puts parents in contact with each other, gives advice on benefits and aids for children, and holds annual events for families. 

Group details last updated December 2014.

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