Erb's Palsy - Treatment
Erb's palsy is an arm injury which is primarily characterized either by weakness and/or paralysis in the arm, depending on the severity of the case. It results from damage to the brachial plexus nerve cluster in the upper arm and most often is caused by complications during delivery. Like other birth injuries, your physician is obligated to diligently recognize risks and signs of this condition ahead of time and take any warranted preventive measures - before, during, and after delivery. If your child is suffering from the effects of Erb's Palsy, this may be a result of medical negligence - either due to an avoidable injury which took place during delivery and/or because your physician failed to adequately diagnose the symptoms when they were initially and readily apparent. If you believe this may be the case, we encourage you to get in touch with us as legal representation can play a crucial role in helping you receive the compensation your family and child deserve.
The question is whether all these therapeutic options we are discussing can make a difference. The overwhelming evidence is that early and effective treatment for Erb's palsy makes a real difference in treatment outcomes. So if you have concerns about your child, take them to you pediatrician.
The success and speed of recovery from Erb's Palsy varies with the severity of the injury and how soon the appropriate intervention was implemented.
The reality is Erb's palsy is usually caused by a medical mistake by what may be an otherwise good doctor during childbirth. The most common cause of Erb's palsy is excessive pulling or stretching of an infant's head and shoulders during a vaginal birth. For example, if an infant's head and neck are pulled to the side at the same time as the shoulders pass through the birth canal, this can cause Erb's palsy.
The treatment of Erb's Palsy depends on its severity. For the majority of cases in which there is only minimal damage to the affected area, the injury may only take a few months (up to 9) to heal. In these cases, the passage of time and moderate use of the affected arm is often enough for the injury to heal. However, physical therapy - the most common treatment for Erb's Palsy - is recommended even in these cases with minor damage in order to accelerate the healing process and increase the chances of a full recovery.Physical Therapy
Your child's physical therapy sessions should ideally be conducted with a professional physical therapist who specializes in pediatric care. In mild cases, physical therapy will consist of a program which assists with healing and strengthening the affected area. In severe cases, it will also be accompanied by surgery. Your physical therapist will begin working with your child, and then teach you how to continue the exercise regimen at home. In addition, a good physical therapist will also provide instruction or care in many of the following areas:
- Identify muscle weakness - Using specific tests, your physical therapist can assess both the location and severity of your child's affliction in order to ensure that the exercise regimen is appropriate and will maximize healing and growth
- Education - In addition, you should ask to provided with any necessary instructions on holding, carrying and playing with your baby in a way that will minimize pain or stress and maximize healing. Much of this is related to positioning - such as ways to keep your baby's arm from hanging when you carry them, or how to lay them down on their back and stomach.
- Injury prevention - Based on identifications of muscle weakness and other medical information at their disposal, your physical therapist should be able to let you know of any possible injuries which could occur which you otherwise might neglect due to your child's potential inability to perceive pain in certain areas as a symptom of Erb's Palsy.
- Holistic plan - Finally, some physical therapists will also provide you at some point with a holistic plan for your child's wellbeing and recovery, limited not just to exercise but also encompassing diet and community involvement.
The primary aspect of physical therapy will be the exercises your child's therapist will first run through with your infant, and then teach you how to continue on a daily basis at home. These exercises will typically consist of many of the following:
- Gentle stretching - both passive and active
- Gentle massage
- Sensory stimulation
- Range-of-motion exercises - to prevent joint contracture (tightness)
- Strength exercises - games, fun tasks, and developmental exercises
To assist with some of these exercises, your child's physical therapist may also suggest or implement the use of specialized equipment, such as splints, braces, and flexible tape to promote joint alignment and help train your child's injured arm to move in a way which facilitates healing. This kind of equipment may also be used in constraint-induced movement therapy, which is applied to the healthy arm to encourage the use of the injured arm and facilitate its healing.
Another method your child's physical therapist may recommend is neuromuscular electrical stimulation, which stimulates the muscles in the affected arm with the electoral current. This form of treatment can help build muscle and improve blood flow, although it is not traditionally used and has only been minimally studied. It may, however, be useful in minimizing the atrophying of muscles that can't be used naturally.
Finally, your physical therapist may also opt to use the method of hydrotherapy, in which he or she will help your baby with strength and mobility exercises while using the anti-gravity setting of water to help take stress off the body. This method can help make movement less painful and enables your infant to build up their strength. It encourages normal movements in the injured arm, strengthens muscles, and reduces spasms. Overall, hydrotherapy can be good for both healing and pain relief.Recreational Therapy
After the initial stages of basic physical therapy, as your child grows they should be encouraged to participate in normal recreational activities, including those which involve arm and shoulder movements. Depending on the progress they've made so far, this may warrant additional assistance and continued therapy. Recreational therapists may help your child with a variety of activities, such as climbing, crawling, throwing, finger painting, picking up and eating food, and/or swimming. As with physical therapy, you should expect to be instructed on how to provide any additional assistance your child might need in carrying out these activities at home.
Botox Therapy - Botox - also known as Botulinum toxin A - is medically injected for many reasons, and its function is to temporarily paralyze muscles at the site of the injection. Although it is derived from a bacterium, this injection is localized and there is little risk of spreading or infection. This method of therapy can improve shoulder flexibility and help weaker muscles develop by temporarily paralyzing functional muscles. For this reason, it is only effective when used along with the regular stretches and exercises of physical therapy.Occupational Therapy
This form of therapy is usually provided after surgery or recommended for those who have sustained long-term damage. An occupational therapist works closely with your child and helps them with tasks like eating, playing, tying shoes, writing, drawing, and more. As with physical therapy, this may need specialized equipment and parents should be provided with home programmes and instructions for continuing treatment at home.Surgery
In more severe cases, surgery is typically required to maximize your child's ability to heal and recover. If there are no signs of healing after sixth months - or your child's doctor or therapist deems recovery to be too slow or inadequate after three to six months, surgery may be necessary. The purpose of this surgery is to repair nerve damage and/or relieve pressure on the brachial plexus nerves to enable natural healing. If possible, physicians will always try to avoid operating on younger patients but will recommend surgery if the injury is severe enough and it's the only option. In some cases, doctors will recommend physical therapy at first, and then only surgery if there is not enough improvement.
After surgery, physicians typically recommend that your child continues with physical therapy as well as occupational therapy for an extended period of time. Unfortunately, in more severe cases your child may still experience issues after surgery and continuing therapy - such as long-term arm weakness/shoulder rotation difficulties. Nevertheless, studies have shown that approximately 80% of patients experience a near-full recovery after surgery.
The two main kinds of surgery which are used to treat Erb's Palsy are:
- Nerve Decompression - This kind of surgery is minimally invasive. It entails a small incision into the skin, followed by the insertion of a specialized surgical instrument that decompresses affected nerves. As a result, the pressure from other body parts is eliminated, which allows for damaged nerves to heal. Of the two forms of surgery, nerve decompression is less comprehensive and typically used in less severe cases.
- Nerve Graft Repairs - In this procedure, the nerves from a healthy sensory nerve are taken from another part of the body as grafting material to repair your child's damaged nerves. Once in place, the regenerating nerve fibers can grow through this graft and connect with their muscles. This procedure can enable a recovery of muscle functions once the injuries repair. Of the two kinds of surgery, this one is the more intensive and typically recommended for more severe cases.
There are also other options if big problems remain after treatment. Although less commonly used, these other options include joint fusion surgery (should arthritis complications arise), and/or additional surgeries at a later date which may continue to help. If necessary, these would be tailored specially to your child's circumstances.Muscle Transfers
As brachial plexus injuries do not always heal evenly, there is a risk that some muscle groups will recover more fully than others which can cause weakness due to imbalance. If severe enough, your child may need a muscle transfer procedure in which your surgeon will move stronger muscles and tendons in order to support those which are weaker.