Surgical Options
A Guide for families
While many children show improvement with physiotherapy and other non‑surgical treatments, some may require surgical intervention to improve arm function and quality of life. Below is an overview of the surgical options that may be considered for children and adults with Erb's palsy.
NERVE SURGERY
Nerve surgery is most commonly recommended for individuals with more severe nerve damage. The main types of nerve surgery include:
-
Nerve graft
A nerve graft involves taking a healthy nerve from another part of the body and using it to repair the damaged nerve. This helps restore the connection between the brain and the affected muscles. -
Nerve transfer
If the damaged nerve cannot be repaired, a nerve transfer may be performed. This involves rerouting a healthy, functioning nerve from a different area to take over the role of the injured nerve.
These procedures are usually carried out within the first year of life, as early intervention can lead to improved outcomes. In some cases, adults with Erb's palsy may also benefit from nerve surgery, depending on the nature and extent of the injury.
Additional surgical procedures that may be considered include:
-
Tendon transfer
A tendon is moved from a functioning muscle to replace the function of a weaker or non‑functioning muscle, helping to restore movement in the affected arm. -
Joint release surgery
Performed where joint stiffness or contractures have developed, this surgery releases tight tissues around the joint to improve movement and comfort. -
Muscle transfer
A muscle is transferred from another part of the body to the affected arm, which can help restore strength and movement, particularly where muscle function is significantly reduced. -
Secondary surgeries
As children grow or adults adapt to living with Erb's palsy, further procedures may be required to address new challenges or refine earlier surgical outcomes. These may focus on improving arm position, movement, strength, or appearance.
WHAT TO EXPECT
Surgical treatment for Erb's palsy is always tailored to the individual. Recovery times vary depending on the procedure, and most surgeries are followed by a structured physiotherapy programme to help maximise recovery and function.
A specialist experienced in brachial plexus injuries will be able to advise on the most appropriate treatment options.
FREQUENTLY ASKED QUESTIONS
Does everyone with Erb’s palsy need surgery?
No. Most individuals with Erb’s palsy make meaningful progress without surgical intervention. Decisions about surgery are highly individual and depend on factors such as the pattern of movement over time, functional ability, and expert clinical assessment. Surgery is considered only where it is felt to offer a realistic benefit.
How are treatment or surgical decisions made?
Decisions are made carefully and collaboratively, following specialist assessment and discussion. The goal is always to support function, comfort, and independence, rather than to pursue intervention for its own sake. What is appropriate for one person may not be appropriate for another.
Is there a “right” time to consider surgery?
There is no single answer. Some procedures, particularly those involving nerves, are considered more time‑sensitive in early life, while others may be considered later in childhood, adolescence, or adulthood. Timing is guided by clinical evaluation, progress over time, and individual circumstances.
What is the aim of surgical treatment?
Surgery is intended to improve movement, strength, balance, or positioning of the arm and to support functional use in everyday life. It does not change the underlying diagnosis and does not aim to create perfect or symmetrical movement, but rather to achieve meaningful, practical improvements.
Will surgery make the arm “normal”?
Surgery does not result in a “normal” arm. Instead, it may help enhance how the arm functions, reduce stiffness, or improve balance between muscle groups. Expectations are carefully discussed in advance so that outcomes are understood and realistic.
Can surgery be beneficial in adolescence or adulthood?
In some cases, yes. While certain procedures are more commonly considered in early childhood, others may be appropriate later, depending on function, goals, and individual assessment. Living with Erb’s palsy is a lifelong experience, and needs and priorities can change over time.
What role does therapy play alongside surgery?
Therapy is an essential component of overall care. Where surgery is undertaken, physiotherapy and/or occupational therapy support recovery, functional use, and adaptation. Even where surgery is not pursued, therapy can play an important role in maintaining movement and confidence in using the arm.
What if we decide not to pursue surgery?
Choosing not to proceed with surgery is a valid and appropriate decision for many individuals. Erb’s palsy is managed in different ways, and quality of life, independence, and participation are not dependent on surgical intervention alone.
Can more than one procedure be needed?
Some people may undergo more than one procedure at different stages, while others may have none. Decisions are revisited as circumstances change, and further intervention is considered only if it is felt to offer genuine benefit.
Who can provide advice and guidance?
Specialist medical and therapy teams experienced in brachial plexus injuries are best placed to advise on treatment options. In addition, speaking with others who have lived experience of Erb’s palsy can be helpful when thinking through choices and expectations.
How should we think about treatment decisions emotionally?
Considering treatment or surgery can feel overwhelming. It is normal to feel uncertain, cautious, or conflicted. Decisions do not have to be rushed, and taking time to ask questions, gather information, and reflect is important. There is no single “right” pathway—only what feels appropriate for the individual at that time.