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When a baby is injured and suffers from Erb’s Palsy, their injury is unique. The paralysis can be partial or complete; the damage to each nerve can range from bruising to tearing. Some babies recover on their own, while some may require specialist intervention. At Oshman & Mirisola, LLP, we put our 35 years of experience to work for our clients, handling every case as if it were the most important one in the firm.
In 80 percent of the babies born with Erb’s palsy, recovery will occur without a surgical intervention. However, a child with brachial plexus palsy can benefit from surgical procedures to increase their arm functions. If recovery does occur, it will be apparent by three to four months of age and will most likely be a stretch injury, the least severe type of Erb’s Palsy. Erb’s Palsy treatment can include occupational therapy, physical therapy, and/or surgery.
If there is no change over the first three months, nerve surgery may be helpful. However, nerve surgery will not restore normal function or help infants over one year old. After surgery, the infant will wear a splint for approximately three weeks. Because nerves grow at a rate of one inch per month, it may take several months, or even years, for nerves repaired at the neck to reach the muscles of the lower arm and hand.
Whether or not surgery is performed is dependent upon the individual child’s condition. Where surgery occurs, it is performed by a pediatric neurosurgeon. The Erb’s Palsy surgical procedure requires special anesthesia, an operating microscope, monitoring equipment, and specialists to be able to expose and identify each of the nerves of the brachial plexus and surrounding structures. Most children with Erb’s Palsy have damage to multiple nerves so more than one procedure must be performed. Erb’s palsy may also be helped by performing daily exercises to both keep muscles limber and to prevent the joints from freezing.
A neuroma Erb’s Palsy treatment might require surgery to restore function because the scar tissue that compresses the nerves is affecting the patient. Surgical Erb’s Palsy treatment may also be necessary because the nerve has been torn at several locations. A surgical procedure, combined with therapy, can sometimes restore the rupture injuries so that closer to normal functioning can exist.
Surgical Erb’s Palsy treatment for avulsion injuries will probably require the most extensive process to restore function. The most severe type of Erb’s Palsy, avulsion injuries mean that the nerves are pulled from the spinal cord. Multiple surgeries, including a muscle transfer might be necessary to reach the highest functioning point of the patient’s ability. Since diagnosing the Erb’s Palsy is not as easy as simply classifying the injuries into one of the four categories, developing an Erb’s Palsy treatment plan can be difficult.
Some children with brachial plexus injuries will continue to have weakness in the shoulder, arm or hand. They may find it difficult to raise the hand over the head, to turn the hand palm up, or to extend the wrist. In some of these cases, a surgical procedure called tendon transfer may be helpful. Tendons are the connective tissues between muscle and bone. The surgeon will separate the tendon from its normal attachment and reattach it in a different place. This is often helpful in improving shoulder and wrist motions as well as elbow position and hand grip.
Your doctor will discuss the various treatment options with you and make a specific recommendation based on your child’s individual situation. Do not hesitate to ask questions; there is much that parents can do to help ensure a good functional outcome.
Because your baby cannot move the affected arm alone, the American Academy of Orthopaedic Surgeons recommends that you take an active part in keeping the joints limber and the functioning muscles fit. Your doctor will recommend physical therapy and range of motion exercises. Do these exercises with your baby every day, two or three times a day, beginning when your baby is about three weeks old. The exercises will maintain a range of motion in the shoulder, elbow, wrist and hand and prevent the joint from becoming permanently stiff, a condition called a joint contracture.
Sometimes, the affected arm is noticeably smaller than the unaffected arm. This occurs because the arm is not used as much. Although the size difference is permanent, it will not increase with age. You should also remember that your child is very adaptable. Be supportive and encouraging; focus on what your child can do. This will help your child develop a healthy sense of self-esteem and adjust to any functional limitations.
If you feel your child suffers from a brachial plexus injury such as Erb’s Palsy and wish to bring legal action to compensate your child for their physical and emotional damages, please call the offices of Oshman & Mirisola, LLP. Contact us today at 1-800-400-8182, or contact us online for a free case evaluation.