Paralysis of muscles in the shoulder, elbow, and/or hand subsequent to a nerve problem is called Brachial Plexus Palsy. The Brachial Plexus is a group of nerves that provide movement and feeling to the arm. This group of nerves connects the spine to the muscles to the arm and hand. When there is a problem with these nerves, the signals going to the appropriate muscles may be blocked or weakened, preventing the muscles from moving normally. In some cases, a problem with the Brachial Plexus also involves partial paralysis of the diaphragm and/or partial paralysis of the eye's pupil on the affected sided. Paralysis of the eye's pupil is referred to as Horner's Syndrome. Partial paralysis of the diaphragm is called hemi-diaphragmatic palsy.

Dr. Wilhelm Heinrich Erb first discovered a version of Brachial Plexus Paralysis. Doctors have described paralysis of the arm in infants dating back to the 1700's; but it was Dr. Wilhelm Heinrich Erb, a German neurologist who located the most common lesion in the 5th and 6th cervical roots which supply the upper trunk of the Brachial Plexus. Injury may occurs today in 1 out of 1,000 births.

It is undetermined what all the causes of Brachial Plexus Palsy are. Researchers have found, it often occurs in cases involving difficult deliveries such as vaginal or cesarian section. Brachial Plexus Palsies in infants can also result when key nerves in the neck or arm have not fully developed. Other variables like weight*, maternal diabetes,
first time or multiparous mothers and difficult births may also play a part in infantile Brachial Plexus Palsy. * (new-borns weighing more than 4000 grams- 8.8 pounds)

There are many degrees of severity in Brachial Plexus Palsy. The upper brachial plexus palsy, or "Erb's Palsy", is the most common type. It primarily affects the muscles of the shoulder and elbow. The lower type, or "Klumpke's Palsy" is uncommon and affects primarily the hand. A true brachial plexus paralysis occurs when all five nerves are affected.

Your child's outlook for the future is positive. Approximately 9 out of 10 infants with brachial plexus palsy can recover on their own. Their ultimate functional outcome will depend on the degree of damage to the nerves and their parent's ability to maintain the
joints supple and maintain their infant's interest in the affected arm during the initial
first few months of life.

The prognosis for the more common Erb's Palsy is considered to be more favorable than in cases of Klumpke's Palsy or in cases of total brachial plexus involvement. The presence of hemi-diaphragmatic palsy or the presence of "Homer's Syndrome" are considered less favorable signs. One out often children who do not get better on their own will continue to have significant weakness and difficulty using the arm in every day activities. Deformities such as a shorter, smaller arm, a permanently bent elbow or internally rotated shoulder are commonly seen in children that do not recover on their own.

Brachial Plexus Palsy is non discriminating. The chance of a child having a brachial plexus palsy is equally distributed according to gender, gestational age and race.
It occurs frequently in perfectly normal and healthy infants. The reported incidence of
brachial plexus palsies statistically is approximately 1 in every 1000 live births.

There is much controversy over the treatment and potential recovery of infants with Erbs Palsy. The main source of this controversy is due to the confusing literature and statistics that are reported by various sources. Stats of full recovery can range from 30% to 95%. Undoubtedly this reflects the specialty of the author. Primary care physicians see many more infants who recover, than the referral physician called on to surgically treat the injury. Additionally, there is the question as to what constitutes a good recovery.