Erb's Palsy Treatment
Erb's palsy treatment involves physical therapy, occupational therapy, medications, and surgery. Erb's palsy affects the brachial plexus, so the main goals of treatment are to protect the joints, keep the arm flexible, and help the nerves and muscles recover as much function as possible.
Can Erb's Palsy Be Cured?
Erb's palsy does not have a "cure" because most cases will heal naturally and recover on their own with time and therapy. In fact, many babies with Erb's palsy do not need any treatment and will typically recover within 3 months to 1 year of life.
In many mild cases, all that's needed is:
- Time to heal (usually 3 to 12 months)
- Moderate use of the affected arm
- Gentle stretching and mobility exercises
In more severe cases, children may need therapy and possibly even surgery to manage symptoms. Because each case of Erb's palsy is different, treatment will vary depending on the level of nerve injury and symptoms involved.
Physical Therapy
Physical therapy is usually the first and most important treatment for Erb's palsy. Regardless of whether the brachial plexus was mildly or severely injured, physical therapy helps to speed up recovery, improve mobility, and regain function and strength in the affected shoulder and arm.
Soon after diagnosis, a physical therapist can teach parents how to:
- Gently move the shoulder, elbow, wrist, and fingers through their full range
- Position the arm so it stays supported but not stiff
- Encourage symmetrical movement, so your baby uses both sides of the body in play
Short, frequent sessions built into diaper changes, feeding, or playtime are often much more effective than long, tiring exercises.
As your child gets older, physical therapy may include:
- Strengthening exercises for the shoulder, elbow, and upper back
- Activities to improve balance and posture if one arm is weaker or smaller
- Play-based tasks like reaching overhead, pushing, pulling, and catching to retrain the arm
Your child's physical therapist will also watch for signs of contractures (tight joints) or shoulder instability so these issues can be addressed quickly.
Occupational Therapy
Occupational therapy focuses on helping children with Erb's palsy with daily activities and fine motor skills. Gaining more mobility and independence early on is important to increase your child's quality of life.
Occupational therapists can help your child with things like:
- Using the affected arm for self-feeding, holding utensils, or bringing a cup to the mouth
- Dressing skills like pulling on a shirt, zipping pants or jackets, or buttoning with help from the weaker arm
- Bilateral play - using both hands together to hold toys, books, or tablets
Occupational therapists may also recommend:
- Adaptive utensils, thicker handles, or angled tools that are easier to grip
- Splints or braces to hold the wrist or elbow in safer positions during sleep or play
- Strategies that help your child participate in school tasks (writing, crafts, computer use)
Are Splints, Braces, or Casting Used in Erb's Palsy?
Some children benefit from orthotic devices and other aids to protect their joints and guide movement. In fact, in some cases, the same mobility aids and assistive devices used for cerebral palsy can help children with Erb's palsy to improve their balance and mobility, and to promote recovery.
Common aids used for Erb's palsy include:
- Soft braces or splints can hold the wrist, elbow, or shoulder in a safer position to prevent contractures.
- Serial casting (short-term, removable casts changed every week or two) may be used to gently lengthen tight muscles.
- Night splints keep the affected arm in a safe position while your child sleeps, so gains from therapy are not lost overnight.
Note: Knowledgeable physical and occupational therapists will carefully balance therapy with the use of supports and devices so that the arm doesn't become overly dependent on bracing.
Surgery for Erb's Palsy
Surgery is not needed for every child with Erb's palsy. However, if there is little or no improvement by around 3 to 6 months, especially in elbow bending and shoulder movement, doctors may recommend early nerve surgery.
Nerve surgery helps repair the brachial plexus nerves and is also beneficial for relieving pressure from the damaged nerves. When done early, surgery can potentially improve recovery outcomes and promote better healing.
The two most common procedures are:
- Nerve grafts - replacing a damaged or ruptured section of the brachial plexus with a healthy nerve graft (usually taken from the leg)
- Nerve transfers - rerouting a functioning nerve from another muscle to power a more important arm muscle that has lost its nerve supply
Some children may need additional surgery to refine movement or correct deformities as they grow older, such as:
- Tendon transfers - moving a working tendon to help a weaker movement (for example, improving outward shoulder rotation).
- Muscle transfers - moving or re-anchoring muscles to improve strength or motion.
- Joint reconstruction or osteotomy - reshaping or repositioning parts of the shoulder to improve alignment and function.
- Contracture release - lengthening tight muscles or tendons that limit range of motion.
In more severe cases of Erb's palsy that require surgery, some arm and shoulder function can be restored, but complete recovery is shown to be less common. However, physical therapy can help to soothe any ongoing symptoms that may persist.
Recovery After Erb's Palsy Surgery
After surgery your child will usually:
- Wear a cast, brace, or sling for a few weeks to protect the repaired area.
- Restart physical and occupational therapy to gradually restore movement, prevent stiffness, and retrain the brain to use new nerve or muscle connections.
- Have regular follow-ups to check strength, growth of the arm, and joint stability.
Parents should remember that nerves take time to grow, often just millimeters per day, so improvements may take months or even years to appear. Early surgery increases the chance that nerves will reach the muscles while they are still able to respond.
Other Treatments for Erb's Palsy
While traditional physical and occupational therapy are the most common treatments, there are many other types of treatments and therapies that help children with Erb's palsy, including:
- Aquatic therapy - warm water can make stretching and movement more comfortable and less intimidating for children. Exercises may involve shallow water tuck jumps, jumping jacks, pushing/kicking off the wall, and other movements that are harder to do in traditional physical therapy.
- Constraint-induced movement therapy (CIMT) - in some cases, gently limiting the stronger arm for short periods while under supervision can encourage your child to use the weaker arm more.
- Play-based sports and recreational therapy - recreational activities like swimming, climbing at playgrounds, and other age-appropriate sports help build strength and confidence when guided safely.
These alternative therapies are great to incorporate alongside traditional physical and occupational therapy. By making activities fun and playful, your child will be more likely to engage and see improved results.
Medications
While medications do not directly treat Erb's palsy or cure nerve damage, they can help to soothe the pain and discomfort of certain symptoms like muscle aches, throbbing, or soreness. Painkillers and anti-inflammatories are the most common medications used.
Parents should always consult with their child's pediatrician and therapists about any medications during treatment.
Botox Therapy
Botulinum toxin, better known as Botox, is used to temporarily paralyze stronger muscles, forcing weaker ones to work harder and build strength. While this may sound alarming, some studies show that children who received Botox treatment improved their range of motion in the shoulder and elbow joints.
In fact, some children who were believed to have needed surgery actually improved their condition and even postponed operations because of how well Botox therapy worked.
Note: Botox therapy is a relatively new treatment, and its risks are not well documented yet. Parents should always consult with their child's doctor or specialist before committing to any kind of treatment or therapy.
How Can Parents Support Their Child with Erb's Palsy at Home?
In addition to physical therapy and professional treatment, parents can help improve their child's condition in many ways at home, such as:
Make Exercises a Part of Daily Life
Instead of "therapy time" feeling separate and potentially stressful, families can:
- Pair stretches with diaper changes, bath time, or bedtime routines.
- Turn exercises into games like "reach for the bubbles," "high-five," or "touch the stickers on the wall."
These routines can make a big impact over time by "disguising" therapy as playful activities to make your child engage better and feel more comfortable moving their body.
Watch for Emotional and Social Impacts
Things like visible differences in arm size or movement can affect self-esteem, especially in school-age children and teens.
Parents can help by:
- Talking about their child's arm in a matter-of-fact and positive way.
- Encouraging them to participate in activities with realistic adaptations instead of avoiding them.
- Connecting socially with other families who have children with brachial plexus injuries for support and ideas.
Find out how Cerebral Palsy Hub can connect your family to resources that can help your child with both cerebral palsy and Erb's palsy.
We can help connect your family with:
Erb's Palsy Treatment FAQs
Written and Medically Reviewed by:
Cerebral Palsy Hub Team
Cerebral Palsy Hub was founded to help support children and their families with cerebral palsy and to create a safe space for those affected. We strive to provide the most accurate, up-to-date information, and tools to help give your child the life they deserve.
Last Updated: December 10, 2025
