What is brachial plexus palsy?
The brachial plexus is a network of nerves that conducts signals from the spine to the shoulder, arm, and hand. The nerves supporting the arm exit the spinal column high in the neck; those that support the hand and fingers exit lower in the neck. Brachial plexus injuries are caused by damage to those nerves. Most brachial plexus injuries occur during birth with a condition called shoulder dystocia. The baby’s shoulder becomes “stuck” against its mother’s pubic bone changing a normal delivery into an emergency situation. Various shoulder dystocia maneuvers may be used to complete the delivery however excessive force may be applied to the baby’s neck and head during the process resulting in stretching and/or tearing of the brachial plexus nerves.
Brachial plexus injuries result in 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. Terms used to describe a brachial pIexus injury include: Erb's Palsy (an upper trunk injury), Klumpke's Palsy (a lower trunk injury), Brachial Plexus Palsy, Horner's Syndrome (when facial nerves are also affected) and Erb-Duchenne Palsy. Torticollis is another term sometimes used in conjunction with brachial plexus injuries.
What are the effects of brachial plexus palsy?
Symptoms of brachial plexus palsy may include a limp or paralyzed arm; lack of muscle control in the arm, hand, or wrist; and a lack of feeling or sensation in the arm or hand. The severity of a brachial plexus injury is determined by the type of damage done to the nerves. Avulsion is the most severe type. This happens when the nerve root is severed from the spinal cord. A neuropraxia, or stretch injury, is the mildest type of injury. Neuropraxia damages the protective covering of the nerve, which causes problems with nerve signal conduction, but does not always damage the nerve underneath. Neuroma occurs when scar tissue develops around the nerve as it heals. The nerve cannot conduct signals from the spine to the arm/hand, because of the pressure put on the nerve by the scar.
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 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)
Large gestational size
Difficult delivery needing external assistance or instruments such as
forceps or vacuum extractor.
Breech presentation at birth
Failure of descent of head during delivery.
Maternal obesity and/or advanced age.
How common brachial plexus palsy?
According to the American Academy of Orthopaedic 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 (See "Nursing Negligence") 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 that 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 other health care professional fails to monitor or to respond properly to certain situations that arise during the delivery, that 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
Failing to respond appropriately to bleeding
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.
Failure to perform a timely cesarean section (c-section) to remove a baby in distress
Failure to successfully resuscitate and intubate newborn
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.
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. Please call our lawyers who handle birth injuries at 1.800.552.7115 or contact us. If you think you have a medical malpractice case within MN, ND, SD, IA or WI, please call 1.800.207.6771.
References and Sources
Erb's Palsy (Brachial Plexus Birth Injury), Your Orthopaedic Connection, American Academy of Orthopaedic Surgeons ("AAOS") http://orthoinfo.aaos.org/topic.cfm?topic=a00077
Erb's Palsy, Brain and Spinal Cord.org,
Brachial Plexus Injuries, Spinal Cord and Nerve Conditions and Diagnosis, Cincinnati Children's, http://www.cincinnatichildrens.org/health/info/neurology/diagnose/brachial-plexus.htm
United Brachial Plexus Network http://www.ubpn.org/index.php
Brachial Plexus, Erb's Palsy, Neurology Department, Mayo Clinic,
Brachial Plexus, Disorders, National Institute of Health,
“Brachial Palsy in Newborns” MedlinePlus Medical Encyclopedia.
Baxley, Elizabeth G., MD and Robert W. Gobbo, MD. “Shoulder Dystocia” Association of American Family Physicians. April 7, 2009, http://www.aafp.org/afp/20040401/1707.html
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