How might delays to treatment affect Erb’s palsy?

As a clinical negligence practitioner, I am aware that delays in treatment are endemic in the NHS at present. Currently there are over 100,000 vacancies, staff retention is not easy, and the infrastructure generally is crumbling – literally, in the case of the buildings. Clinicians are giving care in exceptionally difficult circumstances.

It’s difficult to know precisely how these delays will impact upon care for Erb’s palsy, but plainly some degree of delay does seem likely. Before looking at the possible effects of this, it’s important to consider the condition itself, and the treatment that is generally offered for it.

What is Erb’s palsy?

Erb’s palsy is the result of an injury to a bundle of nerves which together form the brachial plexus – a nerve superhighway which runs down the side of the neck, behind the collarbone, and down each arm.

You can find out more about Erb’s palsy here >

What is the treatment for Erb’s palsy?

Erb’s palsy is caused by damage to the brachial plexus nerves which run along the shoulder behind the clavicle, which is permanent. There is no treatment available which will cure this condition. The treatments that are offered (physiotherapy and surgery, possibly in addition to pain management strategies) aim primarily to optimise movement in the affected limb, and minimise pain and stiffness.

Erb’s is frequently (though not always) treated with surgery, the aims of which are two-fold: the surgeon will try to increase the patient’s range of movement, and also ensure that pain levels are managed. Surgery in Erb’s palsy is not curative, though; an initial “watch and wait” policy may well be a reasonable first response to a brachial plexus injury acquired at birth, and so surgery may not be immediately offered in this situation.  It is generally the case that physiotherapy is offered very early in life, with the aim of maximising range of movement and preventing stiffness in the affected limb. If there is a risk of the shoulder slipping out of joint (“subluxing”) then surgery may be offered.

Find out more about treatments available for Erb’s palsy in our guide >

What if Erb’s palsy is left untreated? Can Erb’s palsy get worse?

If untreated, the nerve injury itself will not get worse, but there can be a range of adverse consequences including loss of movement, loss of muscle tone, pain in the affected limb, and in some instances shoulder dislocation.

Interestingly, there does not appear to be a clear and positive correlation in the literature as between younger age at surgery and better outcome. That said, the earlier surgical intervention is offered to any patient with an obstetric brachial plexus injury, the more time that child will have to benefit from it and develop. Conversely, longer times to surgery must equate to longer times spent having to contend with a reduced range of movement, and increased pain in the affected arm.

It’s not clear how much existing research can inform us of how current delays in the NHS may affect a child with Erb’s: the studies and meta-analyses which have informed treatment prior to now did not take as their starting point an underfunded, resource-poor healthcare sector that is still emerging from a pandemic. Arguably, therefore, we may not be comparing like with like when we apply previous research models to the current, difficult position in which the NHS finds itself. It seems difficult to imagine that the current delays are not having some effect.

I would be very pleased to hear about the experiences of any families with children in this position, and whether they feel that this has impacted upon overall outcome. If we can obtain a sufficient number of responses, the team here would like to explore this issue further with doctors who are working in the field.