Erb's Palsy / Brachial Plexus Palsy

What is Erb’s Palsy (Brachial Plexus Palsy)? 

The brachial plexus is a network of nerves. Those nerves send signals from the spine to the shoulder, arm, and hand. The nerves supporting the arm come from the spinal column, high in the neck. The nerves supporting the hand and fingers come from the lower neck. If your child has a brachial plexus injury, those nerves have been damaged.
Most brachial plexus injuries occur from shoulder dystocia. Shoulder dystocia happens during birth: the baby’s shoulder becomes “stuck” against the mother’s pubic bone. This is an emergency situation. There are various shoulder dystocia maneuvers to use during delivery. Sometimes, excessive force may be applied to the baby’s neck and head during delivery. Excessive force may result in stretching or tearing of the brachial plexus nerves.

Complications of brachial plexus injuries include incomplete sensory and/or motor function of the injured nerve. Nerve injuries vary in severity from a mild stretch to the nerve root tearing away from the spinal cord.

Other Terminology Used to Describe Brachial Plexus Injury

• Erb’s Palsy (upper trunk injury)
• Klumpke’s Palsy (lower trunk injury)
• Homer’s Syndrome (facial nerve injury)
• Erb-Duchenne Palsy (upper nerve injury)
• Horner’s Syndrome (injury to nerve connecting to eye)
• Torticollis (nerve injury affecting neck)

What Are the Symptoms of Brachial Plexus Palsy?

• A limp or paralyzed arm
• Lack of muscle control in the arm, hand or wrist
• A lack of feeling or sensation in the arm or hand

What Is the Severity of a Brachial Plexus Injury?

The severity of a brachial plexus injury is determined by the type of damage done to the nerves.
Avulsion

• The most sever type of brachial plexus injury
• The nerve root is severed from the spinal cord

Neuropraxia

• Damages the protective covering of the nerve
• Causes problems with nerve signal conduction
• Does not always damage the nerve underneath

Neuroma

• A scar tissue develops around the nerve as it heals
• The nerve cannot conduct signals from the spine to the arm/hand because the scar puts pressure on the nerve

What Are the Effects of Brachial Plexus Palsy?

Injuries to the brachial plexus can result in full to partial paralysis of one or both arms. Mild injuries may heal themselves. More serious injuries will require surgery to repair injured nerves. Some options include neurolysis, nerve grafts, nerve transfers, and muscle transfers. A very large population of babies with brachial plexus injuries will have a permanent disability.

Those babies will grow up with limited or no use of the affected arm, sometimes without feeling and with a limp, atrophied arm that marks them as different from other children. They may need multiple surgeries and physical therapy. Children with permanent and severe brachial plexus injuries may suffer a lifetime of pain, therapy, invasive tests, possible surgeries with long recovery times, and emotional distress. 

Are There Risk Factors Associated with Brachial Plexus Palsy?

There are risk factors or warning signs that an experienced obstetrician should be aware of. They include:

• Shoulder dystocia (the baby’s shoulder being restricted on the mother’s pelvis)
• Maternal diabetes
• Large gestational size
• Difficult delivery needing external assistance or instruments such as forceps or vacuum extractor
• Prolonged labor
• Breech presentation at birth
• Failure of descent of head during delivery
• Maternal obesity and/or advanced age

How Common is Brachial Plexus Palsy?

According to the American Academy of Orthopedic Surgeons (“AAOS”), the incidence of brachial plexus palsy is about 1.5 for every thousand babies born.

Medical Mistakes Can Cause Brachial Plexus Palsy

Some injuries from brachial plexus palsy can be attributed to the negligence of doctors, nurses, or other medical personnel. All doctors and nurses owe duties to the patients they serve. When a doctor or other health care professional is determined to be negligent because of a medical mistake during the course of pregnancy or labor, it means they have failed to use the same degree of skill and learning, under the same or similar circumstances, that are used by other members of the medical profession.

Failure to provide pregnancy, labor, or delivery care that is outside the accepted standards of practice can result in significant birth injury, disability, and even death.

If the doctor or health care professional fails to monitor or to respond properly to certain situations that arise during the delivery, those individuals could be considered negligent with regard to the duty owed to patients. 

A delivery medical team should monitor the mother and child throughout labor and delivery in order to be aware of any complications that may develop. Negligence of doctors, nurses, and other medical personnel can arise in any of the following situations: 

• Failure to provide appropriate prenatal care and appropriate interventions during labor and delivery
• Failure to diagnose and treat an infection in the mother
• Failing to rapidly diagnose and treat preterm labor
• Failure to diagnose macrosomic (large) baby
• Failure to properly manage prolonged or post term pregnancy
• Failure to respond appropriately to bleeding
• Placenta abruption   
• Failure to treat maternal preeclampsia or infections
• A negligent management of labor and delivery or delay in delivery
• Failure to appropriately respond and intervene to non-reassuring fetal heart monitor changes and evidence of fetal distress
• Misuse of a vacuum extractor or forceps during delivery
• Failure to perform a timely cesarean (C-section) to remove a baby in distress
• Failure to successfully resuscitate and intubate newborn

About Our Birth Injury Attorneys

Only a careful review of the medical records can determine the cause of injuries and whether the actions of the delivery team played a part in causing the birth injury. Our lawyers and medical analysts who handle birth injury cases have experience investigating medical mistakes and birth injury malpractice and have the resources to access the type of qualified medical experts necessary to review complicated birth injury cases. 

Contact Us for a Free Case Evaluation

If your child suffered an Erb's palsy or brachial plexus palsy injury due to improper care during your pregnancy or at the time of delivery, perhaps we can help. You will be able to speak to a registered nurse who understands the complex issues of labor and delivery that can result in serious injury.

Call 1.800.552.7115 or complete our free case evaluation form to speak to a medical analyst who understands. There is no charge for this call or evaluation.

Our attorneys handle matters primarily in Minnesota, Iowa, North Dakota, South Dakota, and Wisconsin.