Hesperian Health Guides

Chapter 14: Erb’s Palsy: Arm Paralysis From Birth Injury

HealthWiki > Disabled Village Children > Chapter 14: Erb’s Palsy: Arm Paralysis From Birth Injury


Erb’s palsy is a paralysis of the muscles in a baby’s arm, caused by injury of the nerves in the shoulder at birth (during delivery).

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The baby lies with one arm and hand twisted backward and does not move the arm as much as the other.
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If the full range of motion of the arm is not kept through regular exercise, contractures will develop that may prevent lifting the arm above the shoulder or turning the hand palm up.
Severe Erb’s palsy in 14 year old boy. This is as high as he can lift his arm.


Nerve damage causing Erb’s palsy occurs in approximately 1 out of every 400 births. It is much more common in babies who are born butt first (breech) because the shoulder is easily stretched and the nerves injured.


With the baby, start range-of-motion exercises 2 times a day.
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Extend the child’s arm and turn the hand upwards. Then raise the arm straight over the child’s head.
When the child is old enough, have him do exercises himself, for range of motion and to increase strength.
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Ask him to lift his arm as high as he can, turning the palm up as far as he can, and then lift it with the other hand as high as he can, with the palm up.

Note: If contractures have already formed, do exercises more often, for a longer time. Each time try to turn the hand up and lift the arm as high as possible. Hold it in the stretched position while you count to 25, or sing a song.

Other helpful exercises

child swings arm
Swing arm in circle.
child pulls arm up
Pull hard.
child pulls arm to move shoulder
Make circles with shoulder.
child moves arm back and forth
Move back and forth.
child pushes and pulls a stool
Push and pull.

Look for ways to include these exercises in work and play.

different exercises a child can do
Fly a kite.
Sit back with weight on arms.
Push hard!
Buy your child a goat.
Wash clothes. (Squeeze in 1 direction, and then the other.)
Grind maize.
Skip rope.
Swing from trees (palms toward you).
Hang clothes.

Erb’s palsy can sometimes be prevented if the midwife or doctor takes care not to strain or force the baby’s shoulder when being born. Examination of the mother’s belly before birth should let the midwife know if the baby is likely to be born breech. In this case a hospital delivery by a skilled doctor or midwife may reduce the chance of injury.

Contractures and significant disability from Erb’s palsy can largely be prevented by exercises. Some weakness may last throughout life.

This page was updated:21 Nov 2019