Erb's palsy: the most common brachial plexus birth injury

Erb's palsy (also called Erb-Duchenne palsy) is injury to the upper portion of the brachial plexus: the C5 and C6 nerve roots, sometimes extending to C7. Those roots power the shoulder and the muscles that bend the elbow and rotate the arm outward. When they are damaged at birth, the result is unmistakable. The arm hangs at the baby's side, rotated inward with the wrist flexed, the posture clinicians call the "waiter's tip" position.

What parents notice

An arm that didn't move during the newborn exam. An asymmetric Moro (startle) reflex: one arm flares, the other doesn't. Later, a baby who doesn't reach with one hand, can't bring the hand to the mouth, or can't raise the arm overhead. Because C5–C6 spare the hand in classic Erb's palsy, grip is often preserved, which can lull everyone into thinking the problem is minor while shoulder and elbow function stay profoundly limited.

How it happens

The upper roots are the ones placed under tension when the head is pulled away from a shoulder that is stuck, the mechanics of shoulder dystocia. Erb's palsy is the pattern most strongly associated with that mechanism, and it is the most common brachial plexus birth injury. The risk factors, including a large baby, maternal gestational diabetes, operative vaginal delivery, and prolonged labor, are knowable before the injury happens, which is why they matter to the legal analysis.

Prognosis: the months that tell the story

Many infants with Erb's palsy from a mild stretch injury recover meaningful function in the early months, and early physical and occupational therapy protects the joints while nerves heal. But recovery that stalls is significant. A child who cannot bend the elbow against gravity by the middle of the first year is a child specialists evaluate for nerve surgery, and residual deficits that persist past infancy, such as limited overhead reach, weak external rotation, or an arm that lags in growth, are frequently permanent. Permanence is also the dividing line in the legal analysis. It is what separates a difficult first year from a lifetime of accommodation, and it is what a malpractice claim exists to account for.

Florida families' legal position

Erb's palsy is a peripheral nerve injury, so it generally falls outside NICA's exclusivity, and the civil claim is typically available. Florida protects a minor's claim until the eighth birthday, but the practical window for building a strong case is the early years, while the delivery records are complete and obtainable. If your child's Erb's palsy has not fully resolved, the free case evaluation takes three minutes, and I review every submission personally.