Klumpke’s and Erb’s palsy - neonatal and paediatric emergency medicine
Purpose
This entry summarises recognition, ED assessment, immediate management and onward referral for neonatal and infant brachial plexus palsies (Erb’s and Klumpke’s).
It aligns with the Newborn and Infant Physical Examination (NIPE) newborn screening pathway and UK guidance on intrapartum care and specialist management (NIPE; NICE NG235; NICE interventional/HealthTech guidance).
Use this as an ED‑facing, actionable guide to detect injuries, document clearly, provide symptomatic care and arrange timely follow‑up.
Pathophysiology and common causes
Brachial plexus injuries result from trauma to the nerve roots C5-T1. Lesions range from neuropraxia (stretch) to axonotmesis and neurotmesis (including root avulsion).
In neonates the common mechanism is obstetric traction during difficult delivery - especially shoulder dystocia, large birthweight (macrosomia), instrumental delivery and maternal diabetes (NICE NG235). In older children and adults injuries commonly arise from high‑energy trauma or from apical lung tumours (Pancoast).
Clinical patterns - key differences Compare typical features of upper‑ and lower‑trunk injuries:
Mixed or global palsy (weakness across the whole limb) suggests a more severe lesion or root avulsion and carries a worse prognosis.
ED assessment - what to do and document
Follow the NIPE newborn examination pathway: record findings in the newborn notes and the NIPE record, and capture relevant birth details for onward teams.