Brachial Plexus Injuries

Erb's Palsy Treatment in Children at Mayo Clinic

Erb's palsy refers to the most well-known form of brachial plexus injury in infants, caused in most cases by trauma during birth. Erb's palsy affects shoulder motion and elbow flexion. A more serious form can affect the entire arm.

Brachial plexus injuries occur in approximately 1 in 2,000 births, but only about 10 percent of these babies need treatment; most heal on their own. Early evaluation (within the first one to two months of life) is important to determine whether therapy or surgery is required. Mayo Clinic in Minnesota is one of the largest centers in the United States for treatment of Erb's palsy and brachial plexus injuries, performing hundreds of highly specialized and delicate surgeries each year.

The Erb's palsy team at Mayo Clinic includes pediatric specialists from Neurosurgery, Orthopedic Surgery, Neurology and Physical Medicine and Rehabilitation. Team members work closely to deliver integrated, personalized, and comprehensive care to each patient and family.

Treatment Options

Treatment depends on the type and severity of the injury:

• Avulsion — the nerve is torn from the spine
• Rupture — the nerve is torn, but not where it attaches to the spine
• Stretch — the nerve has tried to heal itself (forming a neuroma), but scar tissue has grown around the injury, limiting nerve function

Independent Recovery

Infants with milder injuries often heal on their own, but exercise and therapy are prescribed to ensure full recovery. Regular follow-up appointments track an infant's progress and ensure that the treatment plan is on the right track.

Primary Surgery

Infants with mild injuries who do not heal by 3 to 4 months of age, or those with more severe injuries (such as avulsions or ruptures), need surgery to improve or correct nerve function. This surgery is best performed by a highly skilled, experienced team and ideally should occur within three to six months after birth. After children turn 1 year old, nerve surgery may not be as successful.

Mayo surgeons are highly skilled in microsurgical techniques to make delicate repairs in the nerves, using one or more methods, including:

• Neurolysis — clearing scar tissue from the nerve
• Nerve graft — a nerve is transplanted from the infant's leg to reconnect the damaged nerve(s)
• Nerve transfer — sewing an adjacent, functioning nerve or part of a nerve into a nonfunctioning nerve in an attempt to restore function in a paralyzed muscle

Secondary Surgery

When there is less than full recovery, other conditions sometimes develop involving neighboring joints of the arm. These conditions can result in muscle imbalance or shortening of the muscle (contractures). In these cases, other procedures can be performed when the child is older, typically between ages 2 and 10. Possible procedures include:

• Free muscle transfer
• Capsule release
• Tendon transfer
• Correction of the arm (osteotomy)
• Joint fusion

After Surgery

In many cases surgery restores useful shoulder, elbow and hand function. Rehabilitation specialists and pediatricians assist in the postsurgical care, including prescription of physical therapy exercises and other recommended treatments to help the child function as normally as possible.

Appointments

For more information on treatment of Erb's palsy at Mayo Clinic in Minnesota, contact the Brachial Plexus Clinic at
507-538-1988. Brachial Plexus Clinic staff members will help coordinate your first evaluation for Erb's palsy. After a thorough examination, the physician will be able to recommend what kind of treatment, if any, is necessary.