Treatment of Erb’s Palsy
Ideally, infants with brachial plexus injuries should be referred to a multidisciplinary specialty treatment center. At these treatment centers, medical teams include pediatric neurologists, orthopedic surgeons, neurosurgeons, physical and occupational therapists, and social workers. When a multidisciplinary team is unavailable for care of the injury, the infant should be followed by a pediatric neurologist. It is recommended that infants affected by Erb’s palsy be followed up periodically over a couple of months at regular intervals to assess the recovery.
Non-surgical treatment options
In less severe injuries, gentle massage of the affected arm and range of motion exercises by trained physical and occupational therapists may reduce the symptoms. Parental involvement during physical therapy is important to continue working with the child at home. Home exercises often continue for a long time to improve the child’s ability to use its affected arm. Physical therapy helps prevent joint contractures and focuses on the elbow and forearm where flexion and extension is gently maintained. The child’s affected arm may lose joint flexibility if the muscles are not regularly exercised. Intermittent immobilization and positioning of the affected arm is recommended to prevent contractures. In some cases, electrical stimulation has shown benefits. Botox injections to the shoulder area help rebalance muscles, prevent contractures, and shoulder dislocations, and allow major functional improvements. If neurological function does not return in 6-8 weeks, a surgical referral is recommended because some of these infants might be suitable candidates for microsurgical reconstruction of the brachial plexus to enhance the chance of full recovery after diagnosis of Erb's Palsy.
Surgical intervention yields the best result when performed within the first year of birth, typically during the three-month to six-month period after birth and being diagnosed with Erbs Palsy. Studies have shown that direct nerve surgery is less successful the later it is performed. In cases of avulsion and rupture injuries spontaneous recovery is unlikely, and it is recommended that the infant undergo microsurgical intervention by three months of age for avulsion and within six months for rupture injuries. Microsurgical techniques enable repair of the brachial plexus injury and promise a better rate of recovery.
Exploratory surgery can involve nerve grafting with transplant of another nerve or neurolysis (breaking down of nervous tissue) to remove scar tissue formed from nerve repair. The most significant improvements are reported for nerve grafting. Erb's Palsy Infants who underwent neurolysis or nerve decompression achieved less significant results. For infants with rupture injuries, a donor nerve is inserted into the area of rupture for continuity. Nerve transfers redirect an uninvolved unaffected nerve to the distal site of nerve injury.