Brachial plexus injuries usually occur to larger babies during birth resulting from too much force being applied to the baby's head often through the use of forceps. About three in every 1,000 newborn babies in the UK are affected by brachial plexus injuries the most common of which is Erbs palsy and whilst larger babies are specifically at risk, babies of normal size may also be prone this injury.

The brachial plexus is a network of nerves linking the spinal cord with the arms and hands and over-use of force during delivery may cause the nerves to stretch or rupture, resulting in lack of muscle control in the arm or hand or complete paralysis of the arm. The common brachial plexus injuries are: Erbs palsy; Klumkes palsy and complete brachial plexus palsy, where all nerves of the brachial plexus are affected.

There are certain risks in any delivery and the failure to recognise these and take the necessary precautions by healthcare staff may result in medical negligence causing brachial plexus palsy. Risks of brachial plexus injury include: incorrect estimation of baby's size and then not performing a caesarean section; failure to inform of the risks in vaginal delivery of a large baby and using excessive force during delivery.

If your child has suffered a brachial plexus palsy injury that may be as a result of medical negligence, you should contact an Erbs palsy solicitor as soon as possible to take advice on making a compensation claim against the doctor, hospital or clinic in question.

Medical Negligence

Damage to the brachial plexus nerves usually occurs as a result of the use of excessive physical force during birth. Failure to recognize the risk factors of a potentially difficult birth may amount to medical negligence for which an Erbs palsy solicitor can take legal action to claim compensation. Existence of the risk factors may dictate that a caesarean section is necessary to preclude the possibility of a dangerous traumatic natural birth. Risk factors for Erbs palsy include:

  • failure to diagnose and treat maternal diabetes
  • failure to properly manage shoulder dystocia
  • failure to estimate the baby's weight before delivery
  • applying excessive traction during the delivery

Erbs Palsy Injury

This condition can cause severe disability and is an injury to the brachial plexus which is a network of nerves that runs from the spine, across the chest to the fingers. There are four different common types of injury that may occur causing Erbs palsy:

  • avulsion - the nerve is torn from the spine
  • rupture - the nerve is torn but not where it attaches to the spine
  • neuroma - scar tissue puts pressure on the nerve reducing transmission of impulses
  • praxis - minor consequences where the nerve has been damaged but not torn

Erbs palsy may be associated with other problems which also result from damage to the brachial plexus nerves:-

  • Klumpke's Palsy - limp hand and fingers often associated with Horners syndrome.
  • Complete Brachial Plexus Palsy - Occurs when the entire arm is paralysed.
  • Horner's Syndrome - Caused by damage to the sympathetic nervous system.
  • Torticollis - twisted neck caused as a result of nerve damage.

Horners Syndrome

Horners syndrome is a rare condition may be associated with brachial plexus injury caused during delivery. Horners syndrome is caused by damage to sympathetic nerves that are in close association with the brachial plexus which is a network of nerves that run from the spinal cord, across the shoulder to the tips of the fingers. The damage to the nerves causing Horners syndrome results in a drooping eyelid, constricted pupil and lack of sweating around the affected eye; be it on the cheek or forehead. The damage can occur during pregnancy, from an injury to the carotid artery, a stroke in the brain stem or from medical negligence during delivery.

Shoulder Dystocia

Shoulder dystocia is a medical emergency, occurs when a baby's shoulder becomes lodged behind the mother's pelvis during labour. Excessive traction used in the delivery of the child can damage the 'brachial plexus' network of nerves which runs from the spine, across the shoulders to the tips of the fingers. Failing to remedy this problem can result in asphyxiation and death. Doctors and midwives attending a birth should be familiar with the well-established protocols which if applied appropriately will relieve the problem. The methods of dealing with this serious problem include:

  • repositioning the mother
  • manoeuvring and changing the baby's position
  • carrying out the McRobert's manoeuvre
  • breaking the mother's pelvic bone
  • applying pressure to the pubic area
  • emergency caesarean section
  • breaking the baby's clavicle bone on purpose
  • deep episiotomy cut
  • applying traction in a horizontal plane

Broken Collar Bone

A broken collar bone may result during the birth of a child as a result of Shoulder Dystocia. A deliberate fracture may be unavoidable if the doctor has exhausted every other possible solution for delivering the baby uninjured. The collar bone may be fractured from excessive force in trying to deliver the baby naturally or the doctor may have to make a controlled breakage in order to effect delivery. Other injuries may also be subsequently evident in a traumatic birth including damage to the brachial plexus nerves leading to Erbs palsy. As to who is responsible for the broken collar bone and the chances of a successful compensation claim; this depends on previous birth history of the mother and on her physical condition - is she obese - does she have a flat pelvis and so on. There are also accepted protocols the doctor should follow for dealing with shoulder dystocia. Healthcare providers may be responsible, if there was no sign of shoulder dystocia, the birth was natural and a fracture occurred during delivery in any event.

Erbs Palsy Solicitors

Failure to act in the face of obvious risk or failure to follow the protocols can be grounds to pursue a medical negligence compensation claim if the child suffers any injury. If you think that your child was injured as a result of medical negligence you should speak to an Erbs palsy solicitor about making a claim against the hospital or clinic. Children injured during birth usually receive public funding and legal aid which is not means tested for those under the age of 18 years.

Erbs Palsy Information

Perhaps the most common nerve injury in infants occurs at the time of birth. It is also called brachial palsy and involves a weakness or paralysis of one of the arms of the infant caused by damage to the brachial nerve plexus that runs along the armpit area. It happens when the infant's shoulders are stuck in the birth canal and the doctor doing the delivery pulls too hard on the head in one direction that pulls or breaks the delicate nerves in the armpit and shoulder area.

There are different forms of brachial plexus injuries in the infant, depending on the location of the injury. This can include brachial plexus injuries that only affect the upper part of the arm, Erb's palsy, which affects the upper arm and the way the lower arm is rotated, and Klumpke paralysis, which affects the infant's hand. Incidentally, there can be a droop of the infant eyelid on the opposite side of the body.

The symptoms are often seen soon after birth. The typical Moro reflex is lost on one side of the body in the arm and the arm is generally held flexed at the elbow, held tight against the body. There is a poor grip or grasp on one side of the body and a lack of movement in a spontaneous way on the upper or lower arm. The hand can be affected as well.

Causes of Erb's palsy and other brachial plexus palsies include difficulty in the delivery of the infant. If the infant's head is of normal size but the shoulders are large and out of proportion to the head, the shoulders can get stuck. Too much pulling on the head can contribute to Erb's palsy. A breech delivery can cause excessive tugging on the upper arms as they descend the birth canal and one or both sides of the body can be affected. There is an increased risk of Erb's palsy in situations involving a breech delivery (fortunately uncommon in today's medicine), having a bigger than average sized new-born infant and having shoulder dystocia or stuck shoulders. The advent of caesarean sections has greatly reduced the number of infants that suffer from brachial plexus injuries and other nerve injuries. Fewer instruments are used today to deliver infants so that tugging and pulling are gentler than before.

Certain physical exams and tests can be done to confirm the diagnosis of Erb's palsy or other brachial plexus palsy. The physical exam can confirm the weakness of the muscles and the lack of Moro reflex on the side of the body affected by palsy. If the infant has only weakness or pseudoparalysis of the arm, the Moro reflex will be intact. (In pseudoparalysis, there is actually a fracture of the arm or clavicle that makes movement painful enough to decrease movement of the arm). Another test involves rolling the infant from side to side. The affected arm will be floppy if brachial plexus palsy is involved.

Treatment of brachial plexus palsy involves gentle massage of the affected arm and mild range of motion in order to revive the nerves. If strength to some degree has not returned by the age of three to six months, surgery can be done to connect the nerves and restore function to the arm. There can also be surgeries called tendon transfers that can help the function of the arm and make it work better. In pseudoparalysis, the infant really has a fracture and will begin moving the arm as soon as the fracture heals and the pain is diminished.

What's true is that most infants recover by the age of six months but those that do not recover by then often do not have a good outcome and will need multiple surgeries and will have a residual deficit of the affected arm.

Erb's palsy and other brachial nerve injuries can be prevented by predicting large babies in advance and expecting the potential for complicated deliveries so that there is no tugging on the affected body areas that cause brachial plexus injuries to occur in the first place.



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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here