Brachial Plexus Injury (Erb's Palsy)
A brachial plexus injury affects the network of nerves supplying the arm, and in newborns it usually results from stretching of those nerves during a difficult delivery. At Modern Physio we focus on understanding the root-cause of your problem & personalizing your treatment for lasting results.
Understanding Brachial Plexus Injury (Erb's Palsy)
A brachial plexus injury affects the network of nerves supplying the arm, and in newborns it usually results from stretching of those nerves during a difficult delivery. The most common pattern, Erb's palsy, affects the upper nerves and leaves the arm hanging with limited shoulder and elbow movement. Many babies recover substantially, particularly where nerve stretch rather than tearing has occurred. Physiotherapy starts early and focuses on keeping the joints mobile while the nerve recovers, preventing the shoulder stiffness that otherwise limits the eventual outcome, and encouraging the baby to use the arm as function returns.
Common Symptoms
- Reduced or absent movement in one arm from birth
- The affected arm held against the body with the elbow straight
- Weak grip on the affected side, in lower-nerve patterns
- The startle reflex absent on the affected side
- Difficulty raising the arm at the shoulder
- The baby ignoring or under-using the affected arm
- Stiffness developing at the shoulder if movement is not maintained
How Common Is It?
Birth-related brachial plexus injury is uncommon, and a substantial proportion of affected babies recover well — particularly where the nerves have been stretched rather than torn. Outcome varies with severity, and early assessment establishes which picture applies.
Causes & Risk Factors
- Stretching of the brachial plexus nerves during a difficult delivery
- Shoulder dystocia during birth
- Large birth weight
- Breech delivery
- Assisted delivery in some cases
Our Diagnosis Process
- Birth history and when reduced movement was first noticed
- Assessment of which movements are present and which are absent, to establish the pattern
- Assessment of joint range at the shoulder, elbow, wrist and hand
- Tracking recovery of movement over time — the pattern of return is the most useful indicator
- Prompt referral for specialist opinion where recovery is not progressing, since surgical assessment is time-sensitive
Our Treatment Approach
- Gentle passive movement of the shoulder, elbow, wrist and hand to prevent stiffness while the nerve recovers
- Positioning advice for carrying, sleeping and feeding to protect the arm
- Encouraging active use of the arm through play as movement returns
- Strengthening as recovery allows
- Parent training, since this is a daily home programme rather than a clinic activity
- Regular re-measurement, and referral onwards if recovery stalls
Recovery & Prevention Tips
- Do the passive movements gently and regularly — shoulder stiffness is the main preventable complication
- Support the arm when lifting and carrying your baby; never pull on it
- Position toys towards the affected side to encourage reaching once movement begins
- Dress the affected arm first and undress it last, which is easier and safer
- Attend follow-up even if progress looks good — the timing of specialist referral matters if it stalls
Products That Can Help
Supports and equipment we fit at the clinic that patients with this condition commonly use alongside treatment — never instead of it.
Frequently Asked Questions
Will my baby recover full movement?
Many babies recover substantially, particularly where the nerves were stretched rather than torn. Some have lasting weakness. The pattern of recovery over the first months is the best guide, and you will be given an honest picture as it emerges rather than a prediction at the first visit.
When should physiotherapy start?
Early. Gentle movement to maintain joint range begins well before the nerve has recovered, because a stiff shoulder limits function even after nerve recovery.
Is the passive movement painful?
It should be gentle and within a comfortable range. You will be taught the technique, how far to go, and how often — and you do it at home, several times a day.
Might surgery be needed?
For some babies, where recovery does not progress, specialist surgical assessment is considered — and its timing matters. That is why follow-up and prompt referral are emphasised. Physiotherapy works alongside your paediatrician or neurologist, never instead of them. Modern Physio does not prescribe medication and has no imaging on site; where medical review, investigation or a specialist opinion is needed, you will be told so and referred.
Can I carry my baby normally?
Yes, with care to support the affected arm rather than letting it hang or pulling on it. Positioning advice for carrying, feeding and sleeping is part of the first appointment.
Medically Reviewed
This content was reviewed for medical accuracy by Dr. Surabhi Bansal, BPT, MPT (Ortho) with 14+ years of clinical experience.
At Modern Physio, all medical content undergoes a thorough review process to ensure accuracy and alignment with current physiotherapy standards. Our content is created to educate and should not replace professional medical advice. Learn more about our review process.
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