Erb’s Palsy is Among Preventable Brachial Plexus Birth Injuries

Erb’s palsy is among the birth injuries that a baby may incur during a difficult delivery.

Named for Dr. Wilhelm Erb who first determined the mechanics of the condition, Erb’s palsy is a form of brachial plexus birth palsy. Among the many networks of nerves in the body is the brachial plexus, a bundle of nerves near the shoulder that connects and distributes nerves from the neck down to nerves in the arm.

Damage to the brachial plexus may affect movement or feeling in the shoulder, arm, hand or fingers on the side of the body that suffers trauma. This occurs most often when a baby’s neck is stretched to one side due to a complicated delivery.

In some cases, an infant’s arm will appear to be rotated in toward the body. In other cases, the arm appears to hang limply from the shoulder with the wrist and fingers flexed, a condition nicknamed “waiter’s tip hand.”

Large babies are most at risk for Erb’s palsy, often due to a mother’s gestational diabetes. Other risk factors include either an extremely short or very prolonged second stage of labor or a baby who is breech.

The affected arm is usually immobilized for the first week. Active and passive range of motion exercises with the help of a parent are often recommended in the following weeks. The wrist and fingers might benefit from being splinted to prevent flexing contractions.

When just the upper nerves are affected, the infant might not have control of shoulder movement, but can still move the fingers, which is an indication of true Erb’s palsy. If both the upper and lower nerves become stretched and damaged, the term is total or global brachial plexus birth palsy.

Erb’s Palsy and Similar Birth Injuries

According to Boston Children’s Hospital, the brachial plexus can become injured during birth in a variety of ways. Injuries may include:

• Erb’s palsy specifically affects the upper portion of the brachial plexus, including the C5, C6 and sometimes C7 nerves that affect the muscles of the shoulder and biceps. Boston Children’s Hospital recommends physical therapy at home when the baby is three weeks old. This intervention will keep the joint from becoming stiff, prevent muscle atrophy and prevent the shoulder from dislocating.
• Total plexus involvement affects all five nerves, from C5-T1, and may prevent the child from moving the shoulder, arm or hand at all. Fewer than 30 percent of brachial plexus injuries fall into this category.
• Horner’s syndrome involves injuries to the nerves in the sympathetic chain. Symptoms include a drooping eyelid, smaller eye pupil, and an inability to sweat properly from portions of the face. Up to 20 percent of brachial plexus birth injuries are Horner’s syndrome cases, and most involve avulsion, which means the nerve roots are torn from the spinal cord.
• Klumpke’s palsy is rare in infants, and affects only the lower nerves of the brachial plexus, causing issues with the muscles of the hand on the injured side.

Understanding Whether or Not Medical Malpractice Caused Erb’s Palsy

The diagnosis of Erb’s Palsy could be one that rocks an entire family, especially as you consider the long term complications in treatment that could be required. It is important to remember as a parent that there are some circumstances in which an Erb’s Palsy injury happens for no apparent reason. This is a true accident in which no one is to blame.

In order to proceed with litigation, as a victim, you will need to be certain that the baby’s injuries were caused by medical negligence and errors. There are many different types of circumstances that could contribute to a case like this. These include:

• The physician’s failure to monitor for signs of fetal distress or to respond to signs of fetal distress promptly.
• A physician that fails to plan and carry out an emergency C-section, even when one is warranted.
• A physician who pulls too forcefully on the arms of the baby during the labor and delivery process.
• Improper use of tools, like vacuum extraction or forceps.

It can often be hard for parents, in the heat of the moment, to remember whether or not these actions occurred. Getting a second opinion from another physician can help to identify whether or not the physician deviated from the suggested standard of care, which could lead to a medical malpractice claim if the palsy was caused by a brachial plexus injury. This might require immediate in-home physical therapy.

Often, serious birth injuries such as Erb’s palsy that were incurred during a baby’s birth could have been prevented.

Given that a medical malpractice claim for Erb’s Palsy could cover non-economic damages and economic damages, it is important for parents in this position to consider their next steps and to obtain further information about this condition.