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Erb’s palsy: Features, causes, and treatment

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Have you ever noticed someone with a waiter’s tip hand and wondered what may have caused it? While this particular physical characteristic in humans may seem like a genetic mutation or a disease, in reality, this physical impairment is a birth injury. The waiter’s tip hand is just one of the forms of Erb’s palsy, an injury caused to the brachial plexus nerves. As a result of this injury, the affected arm can become disabled or paralyzed. Most commonly, Erb’s palsy only leads to moderate disability in the arms, but in severe cases, it can cause complete paralysis of the body from below the shoulder.

Causes of Erb’s palsy

Erb’s palsy is caused due to injury to the brachial plexus, which is essentially a group of nerves in the shoulder connecting the arms and the neck. It can sometimes be confused with other injuries in the brachial plexus; however, what sets these different injuries apart is the merger point in the cluster where the injury is caused. Damage in the upper two brachial nerves, C5 and C6, causes Erb’s Palsy. The brachial plexus nerves carry nerve impulses from the brain to the muscles in the arms, hands, and fingers that allow movement and locomotion. Erb’s palsy, however, does not restrict the movement of hands and fingers, but just the affected arm is impaired.

Characteristics of Erb’s palsy

The most prominent characteristic of Erb’s Palsy is the physical impairment of the arm. This disability hinders feeling and sensation in the affected arm and causes immobility that can either be partial or complete paralysis of the body from the neck down. All these factors lead to muscular atrophy. “In some cases, while the disability may not be as obvious, in most cases, especially severe ones, the impairment is far more visible and can be noticed as being abnormal. The arm is not attached correctly and looks seemingly hanging in appearance. The wrist goes outwards, sometimes referred to as a waiter’s tip hand,” states attorney Russell J Berkowitz from Berkowitz and Hanna LLC Malpractice & Injury Lawyers.

Categories and treatment

There are typically four categories of Erb’s Palsy, namely Neuropraxia, Neuroma, Rupture, and Avulsions, all of which are treated differently and have different results of treatment as well. The first one, Nueropraxia, is the mildest form of Erb’s Palsy and results from only minor shock to the nerves instead of tearing. It usually heals within three months of birth and does not require much treatment. A neuroma results from severe stretching and often leads to extreme burning sensations in the arm. It can heal sometimes but not entirely and takes several years. Surgery and physiotherapy are possible treatments for it. Rupture is caused by torn nerves that may need to be grafted by a surgeon from another body part to return to normalcy, and this condition cannot heal without surgery. On the other hand, Avulsion is when nerves get detached from the spinal cord, which restricts arm movement completely. Almost little to no recovery is possible even after surgery.

Since Erb’s Palsy is a form of birth injury caused by tearing of nerves upon vaginal birth, surgeons should be cautious and take preventative measures to reduce the likelihood.


augusta free press
augusta free press
augusta free press

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