Prognosis of Erb’s Palsy
The potential prognostic indicators are the nature of the injury, (for example, avulsion or rupture), extent of the injury (upper or lower plexus injury), and associated fractures of the shoulder, ribs, or arm. Mild and less severe cases of brachial plexus injury resolve within three to six months. Erb’s palsy resolves completely in the first year of life in approximately 70 to 80 percent of patients and in nearly 100 percent of patients if treatment begins within four weeks of birth. Severe injuries may require more than one year of treatment and follow up.
An effective hand grasp during the treatment is associated with good prognosis with arm function returning within a few months. In certain cases if the strength does not return in several months of treatment, the child may have a poor prognosis. In these cases, the injury is often avulsion or rupture with a separation of the nerve root from the spinal cord and there is no scope for recovery without surgical intervention in a timely manner. The potential for neuroma and neuropraxia injuries varies and most patients with neuropraxia injuries recover with nearly 100 percent of function.
There are reports of good functional return in 95 percent of infants diagnosed with Erb's Palsy with more than 90 percent of those recovering showing improvements by 4 months of age. Patients with a lesion of the upper brachial plexus have the best prognosis probably because ruptures are more common in upper nerve roots.
Brachial plexus birth injuries are usually transient although can result in permanent functional deficits depending on the type of injury. Possible complications of brachial plexus injury include abnormal muscle contractions, which may become permanent, and partial or total loss of function of affected nerves causing arm weakness or paralysis.
Psychosocial Impact of Erb’s Palsy
A persistent Erb’s palsy may affect the child’s quality of life and self-esteem, affecting daily activities of life. The child may not be able to participate in team sports. The infant’s disability may also cause psychological distress in their mothers as well. When brachial plexus injury is predicted in infants, more mothers may become depressed.
Obstetric brachial plexus palsy is one of the most devastating complications of delivery and birth trauma. Prevention of brachial plexus injury is of great importance because this injury can be a source of permanent disability to the newborn. Researchers coined the term “fetal-physician risk” to describe obstetric brachial plexus injuries.