Physiotherapy for Erb's Palsy (Brachial Plexus Birth Injury)

What is Erb's palsy?

Erb's palsy is an upper brachial plexus injury (affecting the C5-C6 and occasionally C7 nerve roots) sustained during a difficult birth, often associated with shoulder dystocia. The infant's arm rests in a characteristic 'waiter's tip' posture with the shoulder turned inward, elbow extended, and wrist flexed. Because nerve regeneration is gradual, early and consistent paediatric physiotherapy is crucial. Gentle passive range of motion prevents internal rotation contractures at the shoulder, while sensory play, positioning, and bimanual reaching stimulate neuromuscular development and spontaneous functional return.

How physiotherapy helps

• Gentle passive shoulder external rotation
• Tactile sensory stimulation for arm awareness
• Tummy time and supported weight bearing play
• Bimanual play encouraging reaching and grasp
• Parent coaching for home handling and holding

Common signs

• Reduced or absent spontaneous active movement in one arm noticed in the newborn period
• Characteristic resting arm posture: shoulder internally rotated and adducted, elbow extended, and forearm pronated (waiter tip posture)
• Absent or asymmetrical Moro reflex on the affected side
• Normal finger grasp reflex in pure upper plexus lesions, contrasting with shoulder and elbow weakness
• Early tendency for shoulder internal rotation stiffness if passive stretching is not initiated promptly

Clinical rehabilitation framework

Evidence-informed clinical progression and starter exercise targets for Erb's palsy.

Frequently asked questions

Related conditions & care

Infant TorticollisTorticollis is tightness in a neck muscle that makes a baby hold their head tilted to one side and prefer looking one way. It is common and often improves with gentle physiotherapy, especially when started early, though assessment is still important. Treatment can also help reduce the chance of a flat spot developing on the head.

Developmental DelayDevelopmental delay is when a child is slower than expected to reach motor milestones like rolling, sitting, crawling, or walking. Early physiotherapy supports these milestones with gentle, play-based activities, and coaches parents to help at home, working alongside the paediatrician. Starting early makes the most of a child's rapid early development.

Cerebral PalsyCerebral palsy is a lifelong condition that affects movement and posture, caused by differences in early brain development. Physiotherapy helps manage muscle tightness, maintain and improve movement, and support independence at every stage of life, working alongside the wider care team including your neurologist and paediatrician. For children, early therapy is especially valuable and very play-based.

Scoliosis in ChildrenScoliosis in children and adolescents is a structural three-dimensional curvature of the spine, most commonly presenting as Adolescent Idiopathic Scoliosis (AIS) during periods of rapid skeletal growth. Management focuses on monitoring curve progression through orthopaedic surveillance and Cobb angle measurements. Physiotherapeutic Scoliosis-Specific Exercises (PSSE), such as the Schroth method, complement medical monitoring and brace wear by teaching active 3D self-elongation, rotational breathing, and trunk muscle stabilisation to maintain spinal balance.

Clinical guides & articles for Erb's palsy

Evidence-informed articles, recovery timelines, and home care advice from our clinical library.