Erb's Palsy: Visual Diagnosis in Art before Medical History?

Abstract

Background: Close observation is fundamental to both art and medicine, although both disciplines use it in different ways. As doctors need to practice observation of their patients every day, visual arts are increasingly used for the development of observational skills within the medical curriculum. This is particularly useful for students and residents in surgery or in specializations with a surgical component such as gynecology and obstetrics, where close observation of anatomical structures and radiological imaging is essential in providing quality care. Conversely, artists - through close observation - have depicted the world around them for decades. As a result, they might have unintentionally pictured medical abnormalities, before conditions were officially described in the medical world. Several authors have described medical findings in artworks throughout history, such as the visual diagnosis of Erb's palsy.

Objectives: The aim of this paper was to identify and describe depictions of Erb's palsy in art history.

Methods: Authors observed and analyzed several paintings in the Rijksmuseum in the Netherlands on visual medical abnormalities corresponding to obstetrical birth injuries. Additionally, in January 2025 a PubMed search was conducted using the terms "erbs palsy," "birth injuries," "brachial plexus neuropathies," and "art." The paintings of three articles concerning the depiction of Erb's palsy in art were included. A standardized table was constructed in collaboration with medical specialists and used to analyze clinical features of Erb's palsy in the artworks.

Outcome: PubMed search resulted in three different articles concerning the possible diagnosis of Erb's Palsy in a painting of Albrecht Dürer, i.e., Madonna and Child (ca. 1505). In total, five different paintings from the 16th and 17th century were analyzed regarding the presence of clinical features of Erb's palsy. Three paintings matched six out of seven of the clinical criteria, as stated in the standardized table. Two paintings matched five out of seven clinical criteria of Erb's palsy. It should be noted that the art-historical principles of the so-called Renaissance elbow and the technique of "foreshortening" might have contributed to the depiction of incorrect anatomical features, as a result of artistic freedom rather than the depiction of medical abnormalities.

Conclusions: This paper suggests that artists' close observations could possibly have led to depictions of Erb's palsy centuries before the condition was formally described in the medical profession. The findings serve as a reminder that close observation is essential for the work of medical professionals and highlight how art can contribute to training the clinical eye of medical students, residents, and doctors.