CAUSES OF ERB’S PALSY - by Abasienyene Offiong

What causes Erb’s palsy?The most common cause of Erb’s palsy in newborns is an injury to the nerves around the neck and shoulder during childbirth.To understand how this happens, let's first understand the nerves involved.The brain sends messages through nerves to tell our muscles when to move. A group of nerves called the brachial plexus carries these messages from the spinal cord, through the neck and shoulder region, and into the arm.Some of these nerves help us lift our arms, move our shoulders and bend our elbows.When the nerves are stretched too far or injured, they may not carry messages properly. As a result, the baby may have weakness or difficulty moving the affected arm.The main causes and circumstances A. Difficult childbirthDuring delivery, the baby's head may come out, but one shoulder may become stuck behind the mother's pelvic bone. This is called shoulder dystocia.The healthcare team must act promptly to deliver the baby safely. If the baby's neck and shoulder are stretched too far in opposite directions, the nerves supplying the arm can be injured.This is one of the most important mechanisms behind Erb's palsy in newborns. B. A baby with a larger-than-average birth weightA larger baby may have more difficulty passing through the birth canal, particularly if the shoulders are broad.This can increase the chance of shoulder dystocia and the associated risk of injury to the nerves around the shoulder.However, being a large baby does not automatically mean the baby will develop Erb's palsy. Maternal Diabetes This is an important risk factor to discuss.When a pregnant woman has diabetes, particularly if her blood sugar is not well controlled, the baby may grow larger than expected. This is partly because excess glucose from the mother's blood crosses the placenta, prompting the baby's body to produce more insulin and potentially grow larger.A larger baby may have a higher risk of shoulder dystocia during delivery. If the baby's shoulder becomes stuck and the nerves around the neck and shoulder are stretched or injured, Erb's palsy may occur.The connection is:Maternal diabetes → increased chance of excessive fetal growth → increased risk of shoulder dystocia → possible brachial plexus nerve injury.D. Breech deliveryIn a breech presentation, the baby's buttocks or feet come out first rather than the head.During a difficult breech delivery, pressure or stretching around the baby's neck and shoulders can injure the brachial plexus nervesE. Prolonged or difficult labourCertain difficult labour circumstances, including a prolonged second stage of labour, can be associated with an increased risk of birth-related brachial plexus injury.However, labour being prolonged does not itself prove that Erb's palsy will occur. The specific circumstances and whether nerve injury occurs are what matter. The key messageErb's palsy occurs when the nerves supplying the shoulder and arm are injured, often because they are stretched too far. Childbirth-related risk factors include shoulder dystocia, a larger-than-average baby, maternal diabetes and breech delivery. Traumatic accidents can also cause similar injuries later in life.Understanding these causes helps people appreciate why antenatal care, appropriate delivery planning and early assessment of a baby who is not moving one arm normally are important.

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