Does your baby's hand seem limp? It could be Erb's Palsy. Let's talk!

Have you ever noticed that one of your newborn's arms doesn't move as well as the other? Maybe it's a little lifeless, hanging weakly to the side, right? I understand how scared and worried a mother or father can be when they see that. But don't worry. In most cases, this condition can be caused by Erb's Palsy, which we're going to talk about. Let's talk about everything in a simple way that you can understand.

Simply put, what is Erb's Palsy?

Erb's Palsy is a condition that affects the nerves in our shoulder and arm. This causes the muscles in the arm to become weak or lose their function.

Now let's see how this happens. There is a collection of five main nerves, like a small cable, that run from our back through our shoulders to our arms and hands. We medically call this network of nerves the Brachial Plexus . This bundle of nerves is what brings sensation to our shoulders, arms, and hands, and also sends messages to move them. Think of it like a set of wires that carry electrical messages from the brain to the hands.

If for some reason, especially during childbirth, this nerve network (Brachial Plexus) is pulled or torn, those messages do not get through properly. Then the function of the hand is impaired. This is what we call Brachial Plexus Palsy. Erb's Palsy is the most common type of Brachial Plexus Palsy. Here, the nerves at the top of that nerve network are damaged.

The word "Palsy" means the complete or partial loss of muscle function. It is a condition similar to paralysis.

What kind of damage can be done to these nerves?

The damage to the Brachial Plexus nerves is not the same. It can be divided into four types depending on its severity. It is important to understand this clearly.

Who is most likely to develop Erb's Palsy?

For newborn babies

We often see this condition among newborns. This risk is especially high if the birth is a little difficult. Imagine, sometimes after the baby's head comes out, the shoulder gets stuck in the mother's pelvis. We call this Shoulder Dystocia . Then the doctors have to carefully pull the baby out by tilting the baby's head a little to the side. At that time, the nerves that go from the neck to the arm (Brachial Plexus) can be pulled. Sometimes, even during a cesarean section, there is a very small chance of this situation occurring.

For adults

This condition can also occur in adults, but it is often the result of a serious accident.

• Motorcycle accidents
• Severe falls
• Accidents while playing sports (e.g. rugby)
• Severe injuries, such as stabbings or gunshot wounds

In accidents like this, the brachial plexus nerves can also be damaged.

What are the symptoms of this condition?

If your baby has Erb's Palsy, you may notice these symptoms:

• Arm hanging limply: The affected arm may hang limply parallel to the body.
• Difficulty moving: The baby may not be able to raise his arm at the shoulder or bend his arm at the elbow.
• Loss of sensation: Sometimes there may be tingling or numbness in the hand or arm.
• Waiter's Tip: This is a very specific gesture. The hand position resembles a hotel waiter holding his hand behind his back, expecting a tip from a customer, instead of turning his palm up. The palm is turned back and the fingers are slightly curled inward.

How does a doctor diagnose this?

When you take your baby to the doctor, the first thing they do is do a complete physical exam . The doctor will carefully check the baby's arm movements, muscle strength, and how they feel.

In addition, the following tests may be performed to confirm the diagnosis and determine the exact extent of the damage:

• EMG (Electromyography): This is used to see how well the muscles and nerves are working. By measuring the electrical signals that travel through the nerves, it can be used to find out where the damage is and how severe it is.
• MRI or CT scan: These imaging tests can take clear pictures of the inside of the body and show exactly what damage has occurred to the nerves.
• X-ray tests: Sometimes, if there is a suspicion that a bone in the shoulder has broken during childbirth, an X-ray may be taken to confirm it.

What are the treatments? Will the baby get better?

I know this question is weighing heavily on your mind. The good news is that most babies with Erb's Palsy make a full recovery.

Treatment methods depend on the severity of the nerve damage.

1. Physiotherapy

This is the most important and basic treatment. When your baby is about 3 weeks old, your doctor will refer you to a physiotherapist . There, they will teach you special stretching and range-of-motion exercises to help keep your baby's joints in their hands, arms, and wrists from getting stiff and to strengthen the muscles.

Your role as a parent is very important here. The exercises that the physical therapist teaches you should be done to your baby several times a day, with great love and care. This can help prevent permanent joint contracture .

2. Hydrotherapy

This refers to exercises done in water. Due to the buoyancy of the water, the baby's hands do not feel heavy. Therefore, they can exercise easily and without pain.

3. Botulinum toxin (Botox®) injections

In some cases, your doctor may recommend this treatment. This involves giving a small injection to the undamaged, well-functioning muscles that temporarily deactivates them. This gives the weakened muscles a chance to work and get stronger.

4. Surgery

Most babies do not need surgery. However, if your baby has not made satisfactory progress in hand function by the time they are 6 months old, your doctor may consider surgery.

• Nerve repair: This involves taking a healthy nerve from another part of the body (e.g., the leg) and transplanting it into the damaged nerve ( nerve graft ) or connecting a healthy nerve to a weak muscle ( nerve transfer ).
• Muscle repair: Sometimes a muscle or part of it is taken from another part of the body and transplanted to restore function to the damaged arm.

Can this condition be prevented? What are the risk factors?

Erb's Palsy is not always preventable, as childbirth is a complex process with unpredictable events. However, there are some risk factors that can affect it.

• Increased birth weight of the baby (more than 4 kg).
• The mother has diabetes during pregnancy.
• Maternal weight gain/obesity.
• Having a history of shoulder dystocia in a previous delivery.
• Breech birth.
• Using drugs like Oxytocin or receiving epidural anesthesia during childbirth.

Having these risk factors does not mean that a baby will develop Erb's Palsy. However, it is important to be aware of the risks.

When should I see the doctor?

The best way to get the best results from a neurological disorder like this is to start treatment as soon as possible. Therefore:

• If you notice any changes or weakness in your baby's arm movement, take him to a doctor immediately.
• Be sure to go to the clinic on the date the doctor gives you. It is very important to monitor the baby's progress.
• If you have any problems while exercising at home, or if you feel like your baby's condition is getting worse, call and tell the doctor. Don't keep anything to yourself.