What it is
A short, honest summary.
- —Injury to the brachial plexus — the network of nerves that supplies the shoulder, arm, and hand — usually at birth.
- —Severity ranges from temporary weakness (neurapraxia) to nerve rupture or avulsion.
- —Early, consistent physiotherapy is the single most important determinant of outcome.
What families notice
The signals worth taking seriously.
- 01An arm that hangs limp at the side after birth
- 02Asymmetric arm use as the child grows (preferring one hand exclusively)
- 03Reduced shoulder range — especially abduction and external rotation
- 04A 'waiter's tip' posture: shoulder rotated inward, elbow extended
- 05Asymmetric Moro reflex in newborns
My approach
How the work is structured.
- —Daily passive range-of-motion to prevent shoulder contractures.
- —Play-based active movement work as the child develops.
- —Caregiver training — what to do daily, what to avoid, what to watch for.
- —Coordination with paediatric neurology and, where indicated, surgical teams.
What recovery looks like
A plain-language picture.
“With early intervention, most infants regain substantial or full arm function. Cases needing surgery still respond well to long-term rehabilitation.”
FAQ
Common questions, answered briefly.
- How soon should we start physiotherapy?
- Within the first weeks of life. The earlier we begin, the better the long-term outcome.
- Will my child need surgery?
- Most don't. Surgical referral is considered if there is no biceps function by 3 months — your neurologist will guide that decision.
For clinicians
Clinical detail, assessment and evidence.
Clinical summary
The picture in clinician register.
Erb's palsy is an obstetric brachial-plexus injury, typically of the upper trunk (C5-C6); severity ranges from neurapraxia to rupture or avulsion. Most recover substantially with early range-of-motion and developmental, play-based work; the return of biceps function by around three months is a key prognostic and surgical-decision marker.
Terminology
Terms worth being precise about.
- Brachial plexus
- The nerve network supplying the upper limb; the upper trunk is affected in Erb's palsy.
- Neurapraxia vs rupture vs avulsion
- Increasing severity of nerve injury, with worsening prognosis.
- 'Waiter's tip' posture
- Arm adducted and internally rotated, elbow extended — the classic resting posture.
- Glenohumeral dysplasia
- Shoulder-joint deformity that can develop from a persistent muscle imbalance.
Assessment & measures
What the first sessions measure.
- —Active and passive range, especially shoulder abduction and external rotation.
- —The Active Movement Scale; biceps function tracked against the 3-month marker.
- —Assessment for evolving glenohumeral dysplasia.
Red flags
Signs that need urgent escalation.
- Absent biceps function by 3 months — the threshold for surgical referral.
- Horner's syndrome — suggests nerve-root avulsion.
- A fixed contracture or progressive shoulder dysplasia.
Referral & MDT
When and to whom to refer.
Paediatric neurology. A specialist brachial-plexus surgical service if recovery markers are not met; occupational therapy.
Evidence
References and guideline anchors.
- Early intervention and outcome in obstetric brachial-plexus injury — PLACEHOLDER — verify against current guidelines before launch.