NYU LANGONE · PEDIATRIC BRACHIAL PLEXUS
Erb's Palsy Surgery for Infants and Children
Most infants with Erb's palsy regain arm movement on their own in the first months of life. When recovery stalls, nerve surgery can restore function — and the window for the best results is narrow. Dr. Jacques Hacquebord evaluates and treats brachial plexus birth injuries in infants, children, and adults living with the effects of an untreated injury.
What Is Erb's Palsy?
Erb's palsy is an injury to the upper nerves of the brachial plexus, the network that carries signals from the neck through the shoulder and into the arm. It most often happens during a difficult delivery, when the shoulder becomes caught and the nerves are stretched or torn. The affected arm may hang limply, turn inward at the shoulder, or fail to lift, while grip strength in the hand is often preserved.
Dr. Hacquebord treats the full range of brachial plexus birth injuries alongside the pediatric orthopedic and occupational therapy teams at NYU Langone. Using microsurgical techniques — neurolysis, nerve transfers, nerve grafts, and tendon transfers — he restores movement and sensation after nerve injuries that do not recover on their own.
Nerve tissue heals slowly, and timing affects outcomes. Early evaluation establishes a baseline against which recovery can be measured, so that if surgery becomes the right course, it happens inside the window where reconstruction works best rather than after it has closed.
Why Families Choose Dr. Hacquebord
Specialized Nerve Expertise
Brachial plexus reconstruction is among the most demanding areas of nerve surgery. Dr. Hacquebord performs nerve grafts, nerve transfers, and tendon transfers to restore function after complex nerve injuries that general surgeons rarely treat.
Coordinated Care for Birth Injuries
Brachial plexus birth injuries need more than surgery. Treatment is coordinated with the pediatric and rehabilitation teams at NYU Langone, so splinting, therapy, and surgical timing are managed together rather than in sequence.
Infants Through Adulthood
Some patients arrive as newborns; others arrive as teenagers or adults still living with an untreated birth injury. Both are treatable, and the surgical options differ. Dr. Hacquebord sees the full age range.
Treatment Options for Erb's Palsy
Treatment is planned around the extent of the nerve injury, the child's age, and how much function has returned on its own.
Observation and Therapy
Most birth-related brachial plexus injuries are stretch injuries that recover as the nerves heal. Splinting, electrical stimulation, and occupational therapy protect the shoulder joint and keep the arm usable while that happens, with function tracked at regular intervals.
When Surgery Is Considered
The marker most closely watched is the return of elbow flexion — whether the child can bend the arm against gravity. When that has not returned by around three to six months of age, full recovery is unlikely without surgery, and reconstruction is discussed. Waiting longer matters, because the muscles the nerve supplies gradually lose the capacity to respond. A detailed case study of a nerve transfer performed on an infant with Erb's palsy shows what this looks like in practice.
Neurolysis
Where scar tissue is blocking a nerve that is otherwise intact, releasing that tissue can allow regrowth to resume without grafting or rerouting anything.
Nerve Transfer Surgery
Nerve transfers reroute a healthy, functioning nerve to restore movement to a muscle whose original nerve was damaged. It is one of the most effective tools for regaining shoulder and elbow function after a severe birth injury.
Nerve Grafting
When a segment of nerve is torn beyond direct repair, a nerve graft bridges the gap and gives regenerating fibers a pathway to reconnect.
Secondary Surgery for Older Children
Children who recover partially may still have lasting shoulder tightness or limited rotation. Releasing contracted tissue, repositioning tendons, or rotating the upper arm bone can improve how the arm sits and moves, sometimes years after the original injury.
Frequently Asked Questions
Will my baby's Erb's palsy get better on its own?
Most infants recover arm function within the first few months as the stretched nerves heal. Recovery is tracked at intervals, and the pattern over those months is what determines whether surgery is needed.
At what age should surgery be considered?
The timing turns on whether elbow flexion returns against gravity. When it has not by roughly three to six months, nerve reconstruction is discussed, because the results are better inside that window.
Is nerve surgery safe for an infant?
Brachial plexus reconstruction in infants is performed routinely at specialized centers with pediatric anesthesia and a pediatric surgical team. Risks are discussed against the function expected to be lost if the injury is left alone.
My child is older and was never treated. Is it too late?
No. Nerve reconstruction has a narrower window, but procedures that improve shoulder rotation and arm position remain available into adolescence and adulthood.
Will my child regain full use of the arm?
Outcomes depend on which nerves were injured, how severely, and how quickly treatment began. Many children regain substantial function; some have lasting differences in strength or rotation. What is realistic is discussed after examination and testing.
Schedule an Erb's Palsy Evaluation
Speak with Dr. Hacquebord and the NYU Langone team about your child's brachial plexus injury and treatment options.