Erb’s Palsy

Upper Obstetrical Brachial Plexus Palsy

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

• Upper Obstetrical brachial palsy of the brachial plexus involving C5, C6, and usually C7 Nerve roots¹.
• Upper obstetrical brachial palsy is also called “Erb’s Palsy”¹
• The majority of cases of obstetric brachial plexus palsy involve “Erb’s Palsy”¹.
• Erb’s Palsy lesions are always supraclavicular¹.

Clinical Presentation

Infants with Erb’s Palsy will demonstrate a “Waiter’s Tip posture”¹

Waiter’s Tip Posture

Waiter’s tip posture refers to a position of the paralyzed limb¹. This posture occurs due to paralysis and later atrophy of the deltoid, biceps, brachialis, and brachioradialis muscles¹.

• The GHJ will be internally rotated at the side of the chest¹
• The elbow has 2 variations depending on level of nerve root damage:
  • Elbow Extension is due to paralysis of C5 & C6¹
  • Slightly flexed due to paralysis of C5, C6, & C7
• The forearm is pronated¹
• The wrist and the fingers are flexed¹

References

1.

Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 5th ed. McGraw Hill Education; 2020.