Erb’s Palsy: Physiotherapy for Brachial Plexus Birth Injuries in Coquitlam
Your pediatrician mentioned Erb's palsy or a brachial plexus birth injury. Maybe you noticed your baby's arm doesn't move the same way, or their doctor found it during an exam. Either way, you're probably scared.
Most babies recover well with treatment. The nerves that control the arm were stretched during delivery, and they need time to heal. Pediatric physiotherapy keeps everything moving properly while that healing happens.
Your baby needs both medical monitoring AND physiotherapy. Your doctor tracks nerve recovery and watches for signs that surgery might be needed. Physiotherapy prevents stiffness and maintains function during recovery. Both matter.
What Is Erb's Palsy?
Erb's palsy (also called brachial plexus birth injury) happens when the network of nerves controlling the arm gets stretched or damaged during birth. These nerves - called the brachial plexus - run from the spinal cord through the neck and into the arm.
The injury usually happens during difficult deliveries, especially with shoulder dystocia (when the baby's shoulder gets stuck). Larger babies, breech deliveries, and prolonged labor increase the risk.
What you might notice:
- Arm hanging limp or held against the body
- Can't bend elbow or lift shoulder
- Weak or absent grip in the hand
- Arm turned inward at the shoulder
- No movement when baby is startled (Moro reflex absent on affected side)
Types of injury:
- Upper trunk (C5-C6, sometimes C7) - most common. Shoulder and elbow affected. This is classic Erb's palsy.
- Total plexus (C5-T1) - entire arm affected, no movement at all. More severe.
- Horner's syndrome - drooping eyelid, smaller pupil, reduced sweating on one side of face. Indicates severe nerve damage.
Why Erb's Palsy Needs Both Medical Care and Pediatric Physiotherapy
Your baby's medical team makes decisions about nerve recovery and surgical timing. Physiotherapy focuses on what we can control: keeping joints moving, preventing stiffness, and maintaining muscle function while nerves heal.
Research from Hospital for Sick Children in Toronto shows that brachial plexus injury benefits from comprehensive care - medical monitoring for nerve recovery alongside consistent physiotherapy to prevent complications. Your baby needs both, even if they're not happening in the same room.
Think of it this way: your doctor watches the nerves. Your physio works on everything else. Both are essential.
What Pediatric Physiotherapy in Coquitlam for Erb's Palsy Looks Like
Assessment: Our pediatric physiotherapist in Coquitlam checks:
- Range of motion in shoulder, elbow, wrist, and hand
- Muscle strength (which muscles work, which don't)
- Arm position and posture
- How your baby moves during play and daily activities
- Signs of joint stiffness or contractures developing
Treatment approach: You'll learn a home exercise program to do 4-5 times daily. Nerve recovery is slow - it can take months - and joints get stiff quickly without movement. Consistency makes a real difference in how well your baby recovers.
Daily exercises include:
- Passive range of motion - gently moving your baby's arm through its full range while nerves heal
- Gentle stretching - preventing muscles from getting tight
- Positioning education - how to hold, carry, and position your baby to protect the arm
- Sensory stimulation - different textures, gentle touch to maintain feeling in the arm
- Bimanual activities - encouraging your baby to use both hands together as recovery progresses
Studies show that physical therapy interventions - including stretching, strengthening, and functional activities - improve range of motion and muscle strength in babies with brachial plexus injuries.
Follow-up appointments track progress and adjust exercises. Most babies start with weekly or bi-weekly visits, spacing out as things improve.
Erb's Palsy Recovery Timeline: What to Expect from Physiotherapy
Recovery depends on severity and when treatment starts.
Mild injuries (neurapraxia - nerve stretched but not torn):
- Most babies recover fully by 3-4 months
- May not need surgery
Moderate injuries (some nerves damaged):
- Significant improvement by 3-6 months with consistent PT
- Surgery considered if critical muscles (shoulder, biceps) aren't recovering
Severe injuries (nerve torn or avulsed from spinal cord):
- Limited spontaneous recovery
- Surgery often needed between 3-9 months
- Ongoing PT essential even after surgery
Key milestones doctors watch:
- Biceps and deltoid (shoulder) strength by 3 months
- If these muscles stay weak (M0-M2 on the strength scale) at 6 months, surgery is often recommended
Nerves heal slowly - it can take up to 2 years for full recovery. That's why starting PT early (by 3 weeks old) and staying consistent matters.
Red Flags: When to Contact Your Doctor
These are medical concerns that need specialist evaluation:
- No improvement by 6 weeks - your baby should be referred to a brachial plexus specialist
- Complete arm paralysis - no movement at all
- Horner's syndrome (drooping eyelid, smaller pupil, reduced sweating on face)
- Shoulder dislocation developing - you'll notice the shoulder joint looking abnormal
- No biceps or shoulder recovery by 3-6 months
Physiotherapy can't address these - your medical team needs to evaluate whether surgery is needed.
Common Questions About Erb's Palsy Treatment
"Will my baby recover fully?" Most babies with upper trunk injuries (Erb's palsy) recover well with physiotherapy. Research on gross motor function in brachial plexus injuries shows that while some babies may have lasting weakness or limited motion, many achieve good functional use of their arm.
"Did I cause this?" No. Brachial plexus injuries happen during difficult deliveries - usually shoulder dystocia. Nothing you did caused this.
"The daily exercises feel overwhelming." They are. You're doing stretches 4-5 times daily with a baby who probably cries during them. That's hard. But consistency makes the difference between full recovery and permanent limitation.
"My baby cries during stretches." The exercises aren't painful - they're uncomfortable. Your baby is frustrated and doesn't like being held in certain positions. The crying is hard to hear, but you're not hurting them.
Finding Physiotherapy for Erb's Palsy in Coquitlam
Our pediatric physiotherapist treats babies under 12 months with brachial plexus birth injuries at our Coquitlam clinic. We serve families from Burke Mountain, Westwood Plateau, Austin Heights, Port Coquitlam, Port Moody, and throughout the Tri-Cities. Families from Burnaby, New Westminster, and Surrey also visit our clinic for pediatric physiotherapy.
You don't need a referral to book (though some insurance companies require one for coverage). Most babies are referred by their pediatrician or specialist, but you can also call us directly.
To book: Call us at 604-764-9839 or book online. Mention that you're calling about brachial plexus injury or Erb's palsy for your child.
What to bring: Your baby, any medical records from your pediatrician or neurologist, questions about what you're noticing at home.
If your baby was diagnosed with Erb's palsy or brachial plexus birth injury, don't wait. Early physiotherapy gives your baby the best chance at full recovery. The nerves will heal on their own timeline - our job is to keep everything moving properly while they do.
FAQ
Other Pediatric Physiotherapy Services in Coquitlam
If your baby has other concerns alongside Erb's palsy, or if you're pregnant or postpartum yourself, we treat:
Torticollis - tightness in the neck muscles that causes your baby's head to tilt to one side. Often develops alongside positioning challenges.
Motor Milestone Delays - if your baby isn't rolling, sitting, or reaching movement milestones on schedule.
Prenatal Pelvic Floor Physiotherapy - for pregnancy-related pelvic pain, incontinence, or preparing your body for delivery.
Postpartum Pelvic Floor Physiotherapy - recovering from birth, addressing prolapse, diastasis recti, or pelvic floor dysfunction.
Many families dealing with birth injuries also need support for themselves. We're here for both of you.
