Erb’s palsy is a nerve injury that occurs when the brachial plexus — the bundle of nerves running from the neck to the shoulder — is stretched or torn during birth. Most children recover significantly with early treatment, but the cause is often a preventable mistake during delivery.
Medically reviewed
Updated May 2026
~ min read
1 in 1,000
U.S. babies are born with Erb’s palsy each year — AAOS
3–6 months
When the full extent of nerve injury typically becomes clear
3× higher
Risk of brachial plexus injury when shoulder dystocia is present
What is Erb’s palsy?
Erb’s palsy — also known as Erb-Duchenne palsy or brachial plexus birth palsy — is a nerve injury that occurs when the delicate bundle of nerves running from the neck to the shoulder is stretched or torn during birth, leaving a newborn with muscle weakness or, in serious cases, complete paralysis of the affected arm.
The brachial plexus powers nearly every movement in the shoulder, arm, elbow, wrist, and hand. When it is compromised, the impact on a child’s mobility and development can be significant — especially without early intervention. Erb’s palsy is also a sign that something may have gone wrong during delivery, whether due to physical stress, poor fetal positioning, or a preventable medical error.
If a child shows signs of weakness, limited arm movement, or a noticeable difference in limb posture shortly after birth, further evaluation is essential. Identifying Erb’s palsy early allows children to begin a treatment plan that can dramatically improve their quality of life.
Erb’s palsy typically develops during complicated or high-risk deliveries. The injury occurs when an infant’s neck is forcefully stretched to one side, most often due to shoulder dystocia — when the baby’s shoulder becomes stuck behind the mother’s pelvic bone during birth. See our deeper guide on Erb’s palsy risk factors for a full breakdown of what increases risk.
In these tense moments, excessive pressure applied to guide the baby through the birth canal can overstretch or tear the upper brachial plexus nerves, usually at the C5–C6 vertebral levels. This trauma may result in anything from mild muscle weakness to more severe cases involving a limp arm and complete loss of sensation. Many cases are preventable — see prevention strategies for the obstetric protocols that reduce risk.
Whether the injury heals on its own or requires surgical intervention depends on the type and extent of nerve damage — which is why early and accurate diagnosis is critical.
Can you recover from Erb’s palsy?
According to the American Academy of Orthopaedic Surgeons (AAOS), most children with Erb’s palsy recover significant or full function in the affected limb — especially with early diagnosis, proper physical therapy, and in select cases, surgery. Timely medical care can make all the difference in long-term outcomes. See our guide on long-term effects for the lifespan view.
Recovery depends heavily on the type of nerve injury. Mild nerve stretching (neuropraxia) often resolves within three months with conservative therapy. More severe injuries such as ruptures and avulsions do not heal naturally and require surgical repair. The key is acting quickly: delaying treatment reduces the window for successful nerve regeneration and functional recovery. For families exploring promising treatment frontiers, see our latest research guide.
1 in 1,000
U.S. babies born with Erb’s palsy annually
3 months
When therapy can begin for mild cases
6–9 months
Surgery window for severe cases that don’t respond to therapy
Four types of brachial plexus injury
The type of Erb’s palsy depends on the extent of nerve damage within the brachial plexus. These are classified into four primary categories, each with different implications for recovery and treatment — from mild stretching to complete nerve avulsion.
Mildest
Neuropraxia — nerve stretching
The most common and least severe type. The nerve is stretched but not torn, often producing a burning or tingling sensation along the affected arm. Most infants with neuropraxia regain normal movement and feeling within about three months with conservative care like physical therapy — no surgery required.
Moderate
Neuroma — scar tissue forms
The nerve tears slightly and heals improperly, forming scar tissue that compresses the surrounding healthy nerves. This restricts nerve signals and causes partial muscle function loss. Children may recover some movement but often require targeted therapy — or surgery — to fully restore arm function.
Severe
Rupture — nerve completely torn
The brachial plexus nerve is completely torn, but not at the spinal root. Unlike neuropraxia or neuroma, ruptures do not heal on their own and require surgical intervention. Surgeons perform nerve grafting procedures to bridge the torn ends and restore some level of function to the arm and shoulder.
Most Severe
Avulsion — nerve torn from spinal cord
The most catastrophic type: the nerve is ripped away from the spinal cord entirely, causing permanent nerve damage. This can lead to complete paralysis, muscle atrophy, and in some cases affect the face and eyes. Surgery may offer some functional improvement by rerouting nearby nerves, but the damaged nerve itself cannot be reattached. Avulsions can also cause Horner’s syndrome — drooping eyelids, small pupils, and impaired eye movement.
Erb’s palsy vs. other types of palsy
Not all forms of “palsy” are the same. Understanding the difference is critical when navigating a diagnosis and evaluating legal options.
Erb’s palsy vs. cerebral palsy: Erb’s palsy is caused by physical trauma to the network of nerves in the neck and shoulder — not the brain. In contrast, cerebral palsy is the result of brain damage, often linked to oxygen deprivation or abnormal brain development before, during, or shortly after birth. They require very different treatment approaches.
Erb’s palsy vs. Klumpke’s palsy: Klumpke’s palsy is a much rarer brachial plexus injury. While Erb’s affects the upper nerves (C5–C6) and primarily impacts shoulder and upper arm movement, Klumpke’s involves the lower brachial plexus (C8–T1), causing weakness or paralysis in the hand and forearm muscles. Both interfere with voluntary movement but affect different regions.
Both Erb’s and Klumpke’s palsies are brachial plexus birth injuries and may be caused by excessive force during delivery. Both may support a birth injury lawsuit when medical negligence is involved.
How is Erb’s palsy treated?
Treatment depends on the severity of the nerve damage and how the condition progresses. Mild nerve injuries often respond well to therapy alone, while more severe cases require surgery. Acting early — within the first 6 to 9 months — significantly improves outcomes.
Physical therapy: the first line of care
Physical therapy typically begins as early as three weeks of age when symptoms persist beyond the newborn period. A licensed pediatric physical therapist uses gentle massage, passive and active range-of-motion exercises, and stretching techniques to improve flexibility, reduce stiffness, and build strength in the weakened arm. The goals are to prevent joint contractures, improve circulation, and encourage proper movement in the shoulder, elbow, and wrist. For many children with mild to moderate nerve damage, physical therapy alone can lead to significant functional recovery. Families also benefit from emotional support resources through the rehabilitation journey.
When a child’s grasping, holding, or reaching has not improved over the first four months, occupational therapy may be introduced. OT focuses on rebuilding the motor skills needed for independent everyday activity — muscle tone, fine motor control, and coordination. Through play-based tasks and structured exercises, therapists help children relearn how to use the affected arm and hand effectively, supporting everything from self-feeding to early developmental milestones.
Surgical options for severe cases
When nerve signals fail to return after 6 to 9 months, surgery may be necessary. Time is critical: early surgical intervention increases the chance of long-term recovery.
Nerve transfer surgery is the most common procedure. A healthy nerve from another part of the body is moved and connected to the injured brachial plexus. Over time, new nerve fibers grow into the affected area, reestablishing lost movement.
Tendon transfer surgery relocates a tendon from one muscle group to another, improving motion and stability in the shoulder, elbow, or wrist. These procedures are typically paired with post-operative therapy to maximize recovery.
Delaying therapy or surgery can reduce the likelihood of full recovery. The first few months of a baby’s life are a critical window for nerve healing. The sooner treatment begins, the better the outcome for your child’s mobility and strength.
How difficult deliveries lead to nerve injury
When complications arise during high-stress or prolonged labor, doctors must act quickly to avoid danger. But when excessive force is used or maneuvers are poorly executed, an infant’s neck and shoulder region may suffer serious nerve damage resulting in Erb’s palsy.
This most commonly occurs during complicated vaginal deliveries involving shoulder dystocia — a medical emergency where the baby’s shoulder becomes trapped behind the mother’s pelvic bone after the head has already emerged. When shoulder dystocia is present, the risk of brachial plexus injury increases nearly threefold.
Aside from shoulder dystocia, Erb’s palsy may also stem from fetal positioning or the baby’s size. An awkward position in the womb — such as breech or transverse lie — can increase tension on the brachial plexus during labor. A larger-than-average baby may have more difficulty passing through the birth canal, heightening the likelihood of shoulder entrapment and nerve injury. It is crucial for doctors to recognize and communicate these risks in advance.
Key risk factors for Erb’s palsy
Several conditions during delivery can significantly elevate the risk of brachial plexus injury. Doctors and hospital staff are trained to recognize and respond to these risk factors. When they fail to do so, it may constitute medical negligence.
Shoulder dystocia — the single greatest risk factor; requires specific trained maneuvers to resolve safely
Macrosomia — large birth weight (over 8.8 lbs) increases the likelihood of shoulder entrapment
Use of assistive tools — forceps or vacuum extractors, if misused, can apply harmful lateral traction
Prolonged second stage of labor — a pushing phase exceeding an hour raises stress on the brachial plexus
Forceful pulling on the baby’s arms or shoulders — a direct cause of nerve stretching or tearing
Unfavorable pelvic shape or size — narrow pelvis increases the risk of entrapment
Emergency C-section with significant force — force during extraction can still cause brachial plexus injury
Failure to identify risks before delivery — poor prenatal assessment of fetal size or positioning
While not every case stems from error, many instances of Erb’s palsy are preventable and occur due to poor decision-making or excessive force by the delivering provider. When doctors or nurses fail to act according to accepted standards of care and that failure leads to injury, it may qualify as medical negligence.
Signs and symptoms of Erb’s palsy
Erb’s palsy symptoms often present early — sometimes right after birth — but the full injury may not become clear until a child is several months old. Symptoms primarily affect the shoulder, arm, and hand on one side of the body.
In the delivery room or nursery, the first signs are often visible to medical staff and parents. A newborn might show unusual arm posture or lack of movement on one side. Many children diagnosed with Erb’s palsy experience partial muscle weakness, while others face total paralysis of the affected arm.
If nerve function does not begin to return within the first 3 to 6 months, the damage may be more severe and long-term intervention may be necessary. Common symptoms to look for in the first 6 months include:
Numbness or lack of sensation in the affected arm or hand
Weak grip strength or difficulty grasping objects
Arm held limply at the side, with the palm facing backward or inward
Limited range of motion in the shoulder, elbow, or wrist
Noticeable weakness compared to the unaffected arm
Partial or complete paralysis of the arm
Classic “waiter’s tip” position
One of the most recognizable signs of Erb’s palsy is the arm hanging straight down with the palm facing backward or inward — known as the “waiter’s tip” posture. If you notice this in your newborn, contact your pediatrician immediately.
Symptom checklist: could it be Erb’s palsy?
If your child is showing any of the following signs, consult a medical professional as soon as possible. Early diagnosis opens the door to the most effective treatment options.
Arm hangs straight down and does not bend at the elbow
Palm of the hand faces backward or inward (“waiter’s tip” position)
Baby does not move one arm during crying, feeding, or stretching
One arm appears noticeably weaker than the other
Difficulty gripping or holding toys with the affected hand
Limited motion in the shoulder, elbow, or wrist
Numbness or reduced sensation in the arm
Partial or total paralysis of the arm
Muscle weakness or noticeable lack of muscle tone on one side
Don’t wait for a routine check-up if you suspect something is off. A doctor can assess your child’s condition and recommend early intervention. The first few months of a baby’s life are critical for nerve healing and developmental progress — catching Erb’s palsy early opens the door to the most effective treatments.
Erb’s palsy caused by medical mistakes
Unfortunately, many cases of brachial plexus nerve injury result from medical mistakes by doctors or hospital staff. When a child’s Erb’s palsy could have been avoided with safer delivery practices, families may have legal options — and the right to substantial compensation.
Medical negligence isn’t always obvious in the moment, but it can be identified through expert review of birth records, fetal monitoring logs, and provider decisions. Common errors that lead to Erb’s palsy include:
Applying excessive lateral traction on the head during shoulder dystocia
Failure to recognize and appropriately manage shoulder dystocia
Inappropriate use of vacuum extractors or forceps
Failure to recommend a C-section when fetal macrosomia or pelvic risk factors were present
Inadequate response to warning signs during labor
If a preventable mistake occurred, families may be entitled to compensation to help cover ongoing care, adaptive equipment, physical therapy, surgical costs, and long-term support. Our birth injury lawyers are available 24/7 to discuss your case at no cost — with no fee unless compensation is recovered.
Every state has a deadline for filing a claim. Review the statute of limitations for your state as early as possible to preserve your rights.
Free case review — no obligation
If you suspect medical mistakes played a role in your child’s Erb’s palsy, contact us today to speak with a lawyer or nurse about your options at no cost.
In many cases, yes. A baby may have a limp arm, show little movement on one side, or hold the arm in an unusual position. However, the full extent of the injury may not become clear until around 3 to 6 months of age, especially if the nerve damage is moderate. A pediatrician should assess any asymmetry or unusual limb posture immediately after birth.
Some mild cases — especially those involving nerve stretching (neuropraxia) — can improve without surgery. Most infants with neuropraxia regain normal movement and feeling within about three months with conservative care like physical therapy. More severe types such as ruptures and avulsions require surgical intervention and do not heal on their own.
Treatment depends on the injury type. Early physical therapy and occupational therapy is typically the first step, beginning as early as three weeks of age. More serious injuries like nerve ruptures or avulsions may require nerve transfer or tendon transfer surgery. Acting within the first 6 to 9 months significantly improves long-term outcomes.
The most effective exercises target strength, flexibility, and functional movement in the affected arm and hand. Passive range-of-motion exercises, gentle stretching, and strength-building activities help prevent contractures and restore mobility. Since every case is different, a licensed pediatric physical therapist should create a personalized routine based on the child’s specific condition and developmental stage.
Doctors typically use physical exams and observe reflexes and movement patterns to diagnose Erb’s palsy. In some cases, MRI, ultrasound, or nerve conduction studies (EMG) are used to determine the severity of nerve damage and distinguish between neuropraxia, neuroma, rupture, and avulsion injuries.
Not always, but it can be. If excessive force was used during delivery, shoulder dystocia was mismanaged, or the condition could have been prevented with safer practices, medical negligence may be a factor. In such cases, a legal claim may help families cover the cost of ongoing therapy, surgery, adaptive equipment, and long-term care.
