Understanding Erb’s Palsy (Brachial Plexus Injury): Causes, Treatment Options, and How Early Care – Including Chiropractic – Can Help

Erb’s palsy (also called Erb–Duchenne palsy) is a type of brachial plexus injury that affects the network of nerves running from the neck to the shoulder, arm, and hand. These nerves control movement and sensation in the upper limb. When they’re stretched or injured—most often during birth—the result can be weakness, numbness, or even paralysis of the affected arm.

What Causes Erb’s Palsy?

• Birth-related injury: The majority of cases occur during a difficult delivery, especially when the baby’s shoulder becomes lodged behind the mother’s pelvic bone (“shoulder dystocia”).

• High birth weight or prolonged labor: These can increase the risk of traction on the infant’s neck.

• Instrument-assisted delivery: Use of forceps or vacuum may contribute to stretching of the brachial plexus.

• Trauma after birth (rare): Falls or direct injury can also cause nerve damage.

Why Prompt Attention Matters

Early recognition and treatment improve the chance of recovery. Nerve injuries can lead to muscle imbalance, joint stiffness, and slower development if left untreated. Intervening in the first weeks to months of life allows:

* Better preservation of joint range of motion

* Prevention of muscle atrophy and contractures

* Early referral for physical or surgical interventions if needed

Management depends on the severity of the injury:

• Observation and manual therapy (physical therapy, osteopathy, chiropractic): Mild cases often improve spontaneously. Gentle stretching and range-of-motion exercises prevent stiffness and promote function.

• Occupational therapy: Supports fine-motor skills and sensory recovery.

• Surgical repair (nerve graft or transfer): Considered if there’s little improvement by 3–6 months.

• Orthotics and splinting: May help keep joints in optimal positions during healing.

Studies show that many infants recover significant function with early therapy, while a subset with severe injury may need surgery and ongoing rehabilitation.

How Chiropractic Care May Help – When Integrated Thoughtfully

Chiropractic physicians trained in pediatric care can play a supportive role as part of a multidisciplinary team. Evidence-informed chiropractic approaches emphasize:

• Gentle mobilization of the spine and shoulder girdle to maintain normal joint motion and reduce compensatory strain

• Soft tissue techniques aimed at improving flexibility and comfort

• Parental education on safe positioning, tummy time, and home exercises

• Collaboration with pediatricians, physical and occupational therapists to monitor milestones and ensure coordinated care

Erb’s palsy is a nerve injury that can limit movement and sensation in a child’s arm, but early recognition and therapy greatly improve outcomes. Prompt evaluation, gentle stretching, and—if needed—surgical referral are key steps. If your child shows no improvement in arm movement by 2–3 months, ask your doctor about referral to a brachial plexus specialist.