Erb’s Palsy results from a very traumatic injury when the baby’s shoulder becomes stuck behind the mother’s pubic bone during delivery. Severe nerve damage affecting the neck and arm can result.
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What is Erb’s Palsy?
Erb’s palsy refers to the most common form of brachial plexus injury. The brachial plexus is a network of nerves that transmits signals from the spinal cord to the shoulder, arm and hand. Damage to these nerves can cause partial or total paralysis of muscles in the shoulder, arms, or hands.
Most brachial plexus injuries occur at birth. Approximately one to two babies out of every 1,000 born are affected by Erb’s palsy. Nearly 90 percent of brachial plexus injuries resolve during the first year of life without treatment. The remaining 10 percent of children require exercise, therapy, and, in the most severe cases, surgery. However, even with the best treatment, the most severely injured children will have substantial, lifelong limitations.
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Anatomy of the Brachial Plexus
The brachial plexus is comprised of five spinal nerve roots that exit the spinal cord in the neck. These roots extend through the armpit behind the collarbone, and then branch into nerves that enable movement (motor branches) and sensation (sensory branches) of the shoulder, arm, and hand.
Erb's palsy refers to injuries of the upper brachial plexus, affecting muscles around the shoulder and elbow, and Klumpke's palsy refers to injuries of the lower plexus, which affect muscles of the forearm and hand. Erb's palsy comprise approximately 60 percent, Klumpke's about 5 percent, and mixed (upper and lower trunk involvement) perhaps 35 percent of all brachial plexus injuries.
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The most common mechanism of injury to the brachial plexus during birth is traction of the head and neck in a direction away from the site of injury. This results in a stretching of the nerve roots. Depending upon the degree of stretching, the resulting injury may be a praxis (stretch injury without tearing), rupture (partial tear), avulsion (complete tear off the spinal cord) of the affected nerve roots, or neuroma (in which scar tissue grows around an injured nerve which has tried to heal itself, and interferes with the nerve sending signals to the muscles).
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Treatment of Brachial Plexus Injuries
There are various types of treatment available for children with brachial plexus injuries. The treatment required for any particular child will depend upon the nerve roots injured, and the severity.
Management of brachial plexus injuries must start with an accurate diagnosis, based upon careful physical examination during the newborn period or as soon as is practical, along with any imaging studies, such as magnetic resonance imaging (MRI), CT scanning, or electrodiagnostic studies such as electromyography (EMG) or nerve conduction studies.
A pediatric neurosurgeon and/or microsurgeon should perform an initial evaluation within six to eight weeks after birth, in order to determine whether the child may be an appropriate candidate for nerve reconstruction surgery, which generally must be performed within the first year of life.
Physical therapy and/or occupational therapy should be started as soon as possible, along with instructions to the parents on how to perform range of motion exercises with their child at home.
Children who might not benefit from nerve reconstruction surgery may nevertheless be helped by other types of surgery involving muscle transfers, generally performed as early as age two and as late as age eight. These surgeries may significantly increase function, even though nothing can be done to repair the damaged nerves.
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Can brachial plexus injuries be prevented?
Many cases of brachial plexus injury that occur during childbirth are preventable. Since there are known risk factors increasing the possibility that a baby will be born with a brachial plexus injury, the key to prevention is identification and management of risk factors.
Most brachial plexus injuries occur during deliveries in which shoulder dystocia is encountered. Shoulder dystocia is a condition in which one of the baby's shoulders becomes stuck under the mother's pelvic bone during the birth process. It is considered an emergency, because a rapid, skillful response is required to avoid serious injury, or, in some cases, the death of the baby. If managed properly, nearly all cases of shoulder dystocia can be resolved without any injury to the baby.
Although shoulder dystocia cannot be predicted in advance with certainty, the presence of a large (nine pounds or more) baby significantly increases the likelihood that shoulder dystocia will develop during labor. Babies with mothers who are diabetic are significantly more likely to approach or exceed nine pounds, and therefore special attention must be paid to the possibility of developing shoulder dystocia during delivery of babies of diabetic mothers.
Medical negligence may cause Erb's palsy or other brachial plexus injuries under the following circumstances:
- Failure to obtain a proper prior obstetrical history, including any prior history of diabetes, large babies, or difficult deliveries involving problems such as shoulder dystocia
- Failure to check for, or manage appropriately, diabetes during pregnancy
- Failure to properly manage excessive maternal weight gain
- Failure to appropriately evaluate fetal size by ultrasound during the third trimester
- Failure to timely deliver a post-dates baby
- Failure to assign appropriately qualified personnel to manage the delivery
- Failure to offer the option of cesarean section in the setting of multiple risk factors
- Failure to properly manage shoulder dystocia
- Use of fundal pressure (exerting pressure on the abdomen just below the belly button), which can actually make shoulder dystocia worse
- Exerting excessive force or traction on the head or neck during delivery
- Improper use of forceps
- Improper use of vacuum extractors
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Contact an Experienced Attorney
The experienced medical malpractice attorneys at Kershaw, Cutter & Ratinoff understand that birth injury and birth trauma cases can be complex and demanding. Our attorneys have recovered millions of dollars in damages for injured children and their families who have been the victims of careless doctors and medical staffs.
Our years of experience and our well-trained paralegals and administrative staff give us the advantage, even under the most difficult circumstances. We care about our clients and treat the injured children and their families with genuine concern, because we understand the devastating effects birth injuries can have on them.
If you believe your child is suffering from Erb’s palsy as a result of medical negligence, please fill out and submit the contact form on this page for a free case evaluation or call us toll-free at (888) 285-3333.