Erb-Duchenne palsy is caused by injury to the main group of nerves located in the upper portion of the arm; the C5 and C6 specifically. The amount of damage to this area will greatly affect the kind of treatment necessary to correct it. Living with Erbs Palsy can be difficult as it can results in a paralysis that may resolve itself within months, require therapy or in some cases need surgery.

Most cases of this particular palsy are related to shoulder dystocia; arising from complications during childbirth. Shoulder dystocia occurs when the head is delivered but the shoulder is unable to pass through the pelvic bone without a great deal of manipulation. It is considered an emergency procedure at this point to assist with birth, as the situation can become fatal to the infant within approximately five minutes because of the constricted umbilical cord.

The condition can also present in adulthood due to a serious fall. If a person falls to one side on the shoulder, head and neck stretching the nerves severely this condition results. Other possible causes are repairing a dislocated shoulder and damage due to a gunshot wound.

There are three nerves most affected which include the axillary nerve, the suprascapular nerve and the musculocutaneous nerve. Damage with respect to each nerve can be either tearing or bruising. Partial or complete paralysis is possible as a result.

The Erbs Point is named after Wilhelm Heinrich Erb who was a German neurologist. This is the area that suffers damage and at this point six nerves are joined. Its location is just above the collar bone. All of the nerve fibers along the spine that continue through the neck, armpit and continue through the arm are included.

The major signs associated with this form of palsy are lack of sensation and possible paralysis due to weakening of muscles. The muscles that become weak are the brachialis, biceps, and deltoid. The arm is not usually able to be raised and remains in a position at the side with the hand facing forward. There is a common term known for the position and it is called waiters tip.

Nerve and latissimus dorsi tendon transfers along with subscapularis release are three common forms of treatment. Nerve transfers use nerves taken from the opposing leg and are reserved for babies under the age of nine months due to the possibility of further nerve damage. Limitations do not apply currently to the other two procedures.

Subscapularis release can be done on more than one occasion if necessary to increase the range of motion within the arm, but the muscle may be compromised. Increased sensitivity is possible with the latissimus dorsi tendon transfer due to the position in which the muscle will lie after surgery, but improved external rotation is given to the arm.

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