Can anybody please tell me about best treatment for Erb's palsy?

My 8 years old son is suffering from Erb's palsy in left arm. Extension movements in elbow and shoulder are very poor. So can anybody tell me best treatment for nerve injury.

Hi,
I am a doctor..

The treatment of Erb's paly can be divided into 2 categories..
Non surgical and Surgical...

Nonsurgical Treatment

Because a baby cannot move the affected arm alone, it is important that parents take an active part in keeping the joints limber and the functioning muscles fit. Daily physical therapy and range of motion exercises, done as often as possible during the day, begin when the baby is about three weeks old. The exercises will maintain the range of motion in the shoulder, elbow, wrist, and hand. This will prevent the joint from becoming permanently stiff, a condition called a joint contracture.

Surgical Treatment

If there is no change over the first three to six months, the doctor may discuss exploratory surgery on the nerves to improve the potential outcome (prognosis). Nerve surgery will not restore normal function, and is usually not helpful for older infants. Because nerves recover very slowly, it may take several months, or even years, for nerves repaired at the neck to reach the muscles of the lower arm and hand.

Many children with brachial plexus injuries will continue to have some weakness in the shoulder, arm, or hand. There may be surgical procedures that can be performed at a later date that might improve function.

The doctor will discuss the various treatment options and make a specific recommendation based on each child's individual situation. Do not hesitate to ask questions. There is much that parents can do to help ensure a good return of function.

Children are very adaptable. Parents should be supportive and encouraging, focusing on what the child can do. This will help a child develop a healthy sense of self-esteem and compensate for any limitations in function.

Feel free to write to me for more information..

Does anybody have any information on facilitation techniques for UE reaching with infants with erb's palsy? OT

I'm an occupational therapist and have a child with this and would like to learn some facilitation techniques to use with the infant to develop reach.

IF YOU READ THIS POST EARLIER I HAVE EDITED IT... I'll be checking back here, so if I am totally off track, let me know and I will try to be more helpful. I am a new grad and just started a job in peds.

I did a report on Erb's Palsy in school for OT and have attached an edited copy of my annotated reference list which has some really great websites. I believe I removed all of the information that may not be useful to you. Hopefully all of the links work for you. I know it isn't a quick and easy answer... Sorry.

In addition, I would recommend having the parents massage the limb 2-3 times daily with lotion for sensory input, and during ROM take the child through the PNF diagonals. Basically with Erb's you just want to keep ROM and strength until the nerve regenerates, unless it is an avulsion (detatched at the spinal cord)--then it will never regenerate and compensation is your only route.

Otherwise your major roles are parent education, positioning, ROM, splinting, weightbearing, tactile stim, and strengthening. I have included additional information on each below... I know you are probably already aware of most of this, but sometimes things slip by.

Parent education (lifting, dressing, positioning, etc.)
Lifting child by placing hands under arm pits may cause further injury. Prepostion limp arm on baby’s chest then place one hand under buttocks and one hand behind head to lift.
Dress affected arm first. Undress affeted arm last. This will limit any additional pushing and pulling on the arm.

Positioning tips:
For tummy play position arm in front of chest, elbow bent bringing hand close to baby’s mouth. While sleeping use pillow under armpit to sustain stretch
Do not restrain arm in flexion on top of chest for long periods
Continuously check arm for color (if pale/bluish, reposition immediately)
Offer toys/food to affected arm first to encourage awareness and use of the extremity

ROM and home program (general protocol)
Avoid bringing upper arm close to ear and pushing downward toward the chest
Move one joint at a time, 10 reps in all motions, 2-3 times a day (e.g. diaper changes)

Splinting and braces
Resting hand splint, wrist **** up splint, dynamic splints, air splints, taping

Weight bearing: different positions encourage this during play, provides proprioceptive input

Tactile stimulation: discourages neglect of extremity, sensory re-education

Strengthening: prevent/limit atrophy, work on after recovery of ROM


It is good to know the expected recovery of motor function so you know which movements to expect to come back when:
- Scapular movement (0-3 mos)
- Finger flex/ext (0-3 mos)
- Shoulder flex/abd 40-90 degrees (0-4 mos)
- Elbow flexion (0-4 mos)
- Elbow extension (0-5 mos)
- Shoulder flex/abd 90-160 degrees (4-8 mos)
- Shoulder ext rotation (8-12 mos)
- Supination (10-15 mos)


Good luck. I hope this helps! And sorry for the length of the document. I don't have a lot of time to really go through the information I am copying/pasting for you...

Annotated Reference List

Brachial plexus protocol. (n.d.). Retrieved from the Brachial Plexus Palsy Foundation Web site:
http://membrane.com/bpp/protocol.html...

This article discusses the general types of brachial plexus nerve injury, as well as related complications that can occur following an injury. Conservative treatment techniques through passive range of motion, positioning, splinting, and air splints are covered. Also mentioned is the general timeframe for recovery as well as a referral place for evaluation of need of surgery.

De Moyano, S. S. (2003). Awareness through movement: the Feldnekrais method. Retrieved October 13, 2004, from the United Brachial Plexus Network Web site:
http://www.ubpn.org/awareness/a2003felde...

This article discusses a method founded by Dr. Moshe Feldenkrais. Her method is defined as “a learning system that utilizes movement and awareness of self to bring about… changes.” The basic premise is to teach the client what she can do and build trust and confidence, and then begin working on what she cannot do.

Diffendal, J. (2000, September 11). Splinting for brachial plexus surgeries [Electronic Version].
Advance for Occupational Therapy Practitioners, 32.

Erb’s palsy/brachial plexus play therapy exercises: fun activities to promote range of motion and development. (2000). Retrieved October 13, 2004, from the United Brachial Plexus Network Web site: http://204.157.3.66/resources/playtherap...

This article discusses games and activities geared toward three to six years olds. They are meant to encourage general body activities, hand coordination, and activities of daily living. Also included are general guidelines for encouraging a child to use his or her affected extremity.

Higbee, T. (2003). Baby care for infants with a brachial plexus injury. Retrieved October 13, 2004, from the United Brachial Plexus Network Web site:
http://www.ubpn.org/awareness/a2003babyc...

This article discusses proper techniques for lifting, dressing, positioning, and doing range of motion exercises on an infant with a brachial plexus injury.

Humpl, D. (2003). A therapeutic approach to the waiter’s tip and the erb’s engram. Retrieved October 13, 2004, from the United Brachial Plexus Network Web site:
http://www.ubpn.org/awareness/a2003engra...

This article descrides the two most common postures seen with Erb’s Palsy. It suggests ways to help the child with each posture, including ROM, splinting, neuromuscular stimulation, threshold electrical stimulation, and surgery.

Obstetrical brachial plexus injury (OBPI). (2002). Retrieved October 13, 2004, from the United Brachial Plexus Network Web site: http://www.ubpn.org/awareness/a2002obpi....

This article has a lot of information about OBPI including etiology, diagnosis, prognosis, and sequalae deformities. It also has a nice illustration of the brachial plexus, where it originates on the spinal cord, and how it breaks off into the separate nerves of the arm.

Pape, K. (2003). Threshold electrical stimulation (TES) for brachial plexus injuries. Retrieved October 13, 2004, from the United Brachial Plexus Network Web site:
http://www.ubpn.org/awareness/a2003tes.h...

This article provides information on a conservative treatment technique for children and adults with brachial plexus injuries. The basic premise is to stimulate muscle growth so that when the nerve reinervates the muscle the muscle is not atrophied, but is instead healthy. Basic protocol and related benefits are also discussed.

Shenaq, S. M., Berzin, E., Lee, R., Laurent, J. P., Nath, R., & Nelson, M. R. (1998). Brachial plexus birth injuries and current management. Clinics in Plastic Surgery, 25(4), 527-536.

This article is very thoruough. It discusses the history of obstetrical brachial plexus injuries, incidence, risk factors, pathophysiology, physical examination, clinical presentation and classification, conservative management, and surgical management, including primary and secondary reconstruction.

Storment, M. (2002). Guidelines for therapists: treating children with brachial plexus injuries. Retrieved October 13, 2004, from the United Brachial Plexus Network Web site:
http://www.ubpn.org/awareness/a2002storm...

This article is written by an OT. It contains some general information on what a brachial plexus nerve injury is, as well as the different types of injury. It outlines which muscles
are expected to recover function at what ages. It also discusses when surgical treatment is recommended and general surgical techniques, as well as a more conservative treatment approach.

Stretching the limits: brachial plexus injuries and therapy. (2002). Retrieved October 13, 2004, from the United Brachial Plexus Network Web site: http://www.ubpn.org/awareness/a2002stret...

This article discusses ways to incorporate therapy into daily activities. It includes ideas to use outside, during bathtime, while dressing, with the child helping to cook, and several games. These are great ideas for a busy parent to make the best use of time spent with their child while still having fun.

Therapy services. (n.d.). Retrieved from the Brachial Plexus Palsy Center Web site: http://www.brachialplexus.wustl.edu/trea...

This article discusses the functions performed by therapists when it comes to treating brachial plexus palsy. Included aspects are home exercise programs, positioning,
splinting, and post surgical therapy.

Is their anyone who has a child with Erb's Palsy? Is their anyone who has a child with Erb's Palsy?

No and I don't know anyone with it either sorry I couldn't help

My 4 month old was just diagnosed with erb's palsy. I was wondering if anyone else had this, how it happens (we did an xray and she had no breaks and she has had problems with her neck and arm since birth. She was a planned c-section although a week before I had her I started contractions that caused he heart rate to fall because of dehydration. The hospital said that if it was not the weekend they would have taken her then but not all the staff was available during the weekend.). Plus, I want to know how well therapy helped. Thanks.

Yes I was diagnosed with Erb's Palsy at birth, my mother had a horrendous badly managed labor and I was eventually delivered by Anderson's Forceps..my left arm got wedged behind my mothers pelvic bone, thus It got wrenched. My parents were told I would always be paralysed in that arm; however my parents being Dr's refused to accept this and did regular exercises and as a result no permanent damage was done..whether the exercises actually helped or erb's Palsy was incorrectly diagnosed is another story...I was only told recently when my mother came across my medical notes...I would have never known, my arm made a complete recovery..

My 1 year old daughter randomly stops using her arms. After a few hours she regains total movement of it as if nothing ever happend.

IT IS NOT ERB'S PALSY
MAY BE SHE HAS PAIN, OR A HABIT
CONSULT YOUR DOCTOR

I'm 18 and have Erb's Palsy. I'm looking for a forum, group, or something for people who have it. Everywhere I go, it's support for the parents, but there is no real support for the kids. I didn't meet anybody who also had it until my Senior year of high school (we never became friends). I really just want someone to talk to who actually understands all my problems and who I can relate to.

I have erb's palsy and I am 38 years old. I have it in my right shoulder and arm. The funny thing is that I am right handed. As you get older it is becoming very painful, but with God's good grace I keep moving. I have 9 beautiful children and a wonderful husband who doesn't look at my disability. My children forget at times that I have this condition. I used to hate when people would stare at me I was a child. I learned that they had the problem not me. My parents raised me to be strong and use your mind. The best thing that I can tell you is to exercise. Don't hurt yourself but try to build your strength up if you can. Don't feel bad there is no support for adults who have the condition just parents.

I am an 18 year old girl and I have Erb's palsy on my right arm.
My arm and hand look very disfigured and it really gets me down, I have to keep it covered all the time.
Has anyone ever heard of a nerve and arm transplant? I can't ever seem to find anything.
Thanks for any help!

The nerve transplants are usually performed on babies under the age of 9 months. There are other options as well for older children, but I am not sure about age limitations. 18 might be too late. As far as I know, at some point the injuries get to a point of no possible repair.

There is a bit of info at the Mayo Clinic's website
http://www.mayoclinic.org/brachial-plex ... palsy.html
and at Wikipedia at
http://en.wikipedia.org/wiki/Erb%27s_palsy

I recommend that you get evaluated by a neurosurgeon and find out what options you have. The sooner the better.
Generally speaking, major cities, university hospitals have good neurosurgeons on staff. Your family doctor or nurse practitioner should be able to refer you to the right professional.
Best of luck!

PS: You are not a lesser person because of your arm. Don't let it upset you. People will like you for who you are, and the ones who have an issue with your arm, are not worth knowing.

My daughter, who is 12 , has Erb's Palsy and has partial paralysis in her left arm. I am worried because she is going to start jr. high next year. Right now she is in a small private school and the kids don't tease her about it but next year she wants to go to public school. Everyone says it's not noticable, but I think they are just being nice. Although her left arm measures at the same length as her right it looks shorter and it is especially noticable when she runs. She is a great kid and doesn't let it hold her back, she plays basketball on her school's team and is awesome! She was also a cheerleader last year. But public school with a bunch of 12-13 year old kids is a whole different situation. I have been worried about this since the day she was born. She's had 2 surgeries and countless hours of occupational therapy but nothing has helped. Does anyone have experience with this? What do I say to her if someone makes fun of her? I want to shelter her forever but I know I can't.

Sounds like a great kid.........she will find friends and jerks in the new school.just like where she is now...............give love when she needs it.............and let her tough it out.There will be more friends than jerks.................