Understanding Erb’s Palsy and Brachial Plexus Injuries at Birth
Erb’s palsy is a condition caused by damage to the brachial plexus—the network of nerves that runs from the spinal cord through the neck and into the shoulder, arm, and hand. When these nerves are stretched, compressed, or torn during delivery, the result can be partial or complete paralysis of the affected arm. While some brachial plexus injuries heal with time and therapy, others cause permanent disability that affects the child for life.
At Parker & Parker Attorneys at Law, we represent Peoria-area families whose children suffered brachial plexus injuries during delivery. In many cases, these injuries are caused by excessive force applied by the delivering physician and are entirely preventable.
How Brachial Plexus Injuries Happen During Delivery
The most common scenario leading to a brachial plexus birth injury is shoulder dystocia—a delivery complication where the baby’s head delivers but one or both shoulders become lodged behind the mother’s pubic bone. When shoulder dystocia occurs, the delivering physician must use specific maneuvers to free the trapped shoulder. If the physician instead applies excessive downward traction on the baby’s head and neck, the brachial plexus nerves can be stretched beyond their tolerance and damaged.
Risk factors for shoulder dystocia include a large baby (macrosomia, typically over 8 pounds 13 ounces), maternal gestational diabetes that has led to excessive fetal growth, a prolonged second stage of labor, maternal obesity, and a history of prior shoulder dystocia deliveries. When these risk factors are present, the standard of care requires the medical team to anticipate the possibility of shoulder dystocia and plan accordingly—including considering whether a planned cesarean delivery is the safer option.
Types and Severity of Brachial Plexus Injuries
Brachial plexus injuries range widely in severity. A neuropraxia (stretch injury) is the mildest form, involving stretching of the nerve without tearing. Most neuropraxias heal on their own within three to six months. A neuroma involves more significant nerve damage that produces scar tissue as it heals, which can press on the healthy nerve and cause partial but incomplete recovery. A rupture is a tear in the nerve itself (but not at the spinal cord), which typically requires surgical intervention. An avulsion is the most severe form, where the nerve root is torn completely from the spinal cord, and direct repair is not possible.
Erb’s palsy specifically refers to damage to the upper brachial plexus nerves (C5-C6), which primarily affects the shoulder and upper arm. Klumpke’s palsy involves the lower brachial plexus nerves (C8-T1), affecting the forearm and hand. Total brachial plexus palsy involves all nerve roots and results in complete paralysis of the entire arm.
Signs and Diagnosis
Brachial plexus injuries are typically identified shortly after birth. The hallmark sign is a newborn who holds one arm limp at the side, often with the arm rotated inward and the wrist flexed—sometimes called the “waiter’s tip” position. The baby may not move the affected arm spontaneously or may show an asymmetric Moro (startle) reflex. In severe cases, the entire arm hangs motionless.
Diagnosis is confirmed through physical examination and may include nerve conduction studies, electromyography (EMG), and MRI imaging to assess the extent of nerve damage. Early diagnosis is important because it guides treatment decisions and helps establish the prognosis for recovery.
Treatment and Long-Term Outlook
Treatment for brachial plexus birth injuries depends on the type and severity of nerve damage. Mild stretch injuries are typically managed with physical therapy and gentle range-of-motion exercises to prevent joint contractures while the nerve heals. If significant recovery has not occurred by three to six months of age, surgical consultation is recommended.
Surgical options include nerve grafting (replacing damaged nerve segments with donor nerve tissue), nerve transfer (rerouting a functioning nerve to restore function to the damaged area), and in some cases, later orthopedic procedures such as tendon transfers or osteotomies to improve limb function. Even with optimal treatment, many children with moderate to severe brachial plexus injuries experience permanent limitations in arm strength, range of motion, and function.
When Is a Brachial Plexus Injury Malpractice?
A brachial plexus birth injury may constitute malpractice when the delivering physician used excessive lateral traction on the baby’s head during delivery, the medical team failed to anticipate shoulder dystocia despite the presence of known risk factors, the physician did not employ the recognized maneuvers for resolving shoulder dystocia (such as the McRoberts maneuver, suprapubic pressure, or the Gaskin maneuver) before resorting to forceful traction, or the physician failed to offer or recommend a cesarean delivery when the risk of shoulder dystocia was high.
Expert testimony from an obstetrician is essential to establish what the standard of care required in the specific clinical situation and whether the defendant’s actions constituted negligence.
Compensation for Erb’s Palsy and Brachial Plexus Injuries
Families of children with brachial plexus birth injuries can seek compensation for surgical and rehabilitation costs, ongoing physical and occupational therapy, adaptive equipment and assistive devices, pain and suffering, reduced range of motion and limb function, psychological effects of living with a visible disability, and the child’s reduced future earning capacity if the injury affects their ability to work. The value of a brachial plexus case depends heavily on the severity of the injury and whether the child achieves full recovery or is left with permanent limitations.
Contact Us About Your Child’s Injury
If your child was diagnosed with Erb’s palsy, Klumpke’s palsy, or another brachial plexus injury following delivery, Parker & Parker can evaluate whether medical negligence was involved. Call 309-673-0069 or contact us online for a free consultation.
Related pages:
- Birth Injury Attorney in Peoria, IL
- Cerebral Palsy and Birth Injury Claims
- C-Section Errors and Delayed Delivery
- Medical Malpractice Attorney