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Medical Malpractice

Erb’s Palsy

In addition to representing families of children who have cerebral palsy, we have also successfuly litigated cases involving Erb’s palsy. When a child is born with an arm that’s essentially not functioning or very limited because of damage to the brachial plexus nerve this is called Erb’s Palsy. Nerves run from the neck and empower the shoulder, arm, and hand to move. That type of injury usually results when an error occurs during labor and delivery called shoulder dystocia. Shoulder dystocia occurs when the baby’s head present properly, but the shoulder of the baby cannot pass out of the birth canal. The shoulder gets lodged against the pubis of the mother and as a result the doctor may apply too much traction and actually pull the head and stretch the nerve muscles as the shoulder is impacted against the mother pubis bone. That stretching damages and in some times avulses and severs the nerves leaving the baby with essentially a useless hand and arm. This is a very tragic and avoidable injury. It can lead to lifelong disfigurement of the child and an inability to use the arm for any useful purpose.

Detailed explanation of the condition

Named for one of the first doctors who identified it, Erb’s palsy is a condition that results from an injury to the upper arm in childbirth. Abnormal labor or prolonged births are typically associated with the injury that may cause paralysis. Usually occurring when pressure stretches an infant’s neck and head too far to the side while the shoulders emerge, the injury can result from undue force in delivery as well. Abnormalities in the uterus can damage the nerves prior to birth.

Understanding the Effects of Nerve Injury

Erb’s palsy occurs in the brachial plexus, a nerve network that controls movement and affects sensation in an infant’s arm, hand and shoulder. Erb’s palsy affects the upper nerves, usually allowing an infant to move fingers but not the shoulder. When lower nerves are damaged as well, total or global brachial plexus birth palsy occurs. Nerve damage affects a limb’s rate of growth, and an affected one is usually smaller than the one that is not. Symptoms include weakness, lack of feeling, and either total or partial paralysis. Doctors may initially test for damage to joints and bones in the neck with ultrasound or x-ray. Further testing for nerve signals in the upper arm may include a nerve conduction study or an electromyogram.

Considering Treatment

Many newborns improve without treatment, but the slow rate of growth and repair of nerves may require as much as two years to achieve complete recovery. Nonsurgical treatment presents options for consideration if no improvement occurs within age three to six months, and surgery may prove beneficial later.

Nonsurgical Options
Providing physical therapy and range of motion exercises every day is an approach that doctors recommend. Exercises contribute to making joints limber and muscles fit. Caregivers usually need instruction from a physician or physical therapist to conduct the therapy sessions properly. Infants may have limited use an affected arm, making the participation of trained adults essential. Beginning when a baby is as young as three weeks, the exercises focus on the shoulder and the hand, wrist and elbow. Strengthening the limb with active movement helps prevent joints from forming joint contracture, a condition that makes them permanently stiff.

Surgical Options
Considering surgery to repair damaged nerves is an option if an infant shows no improvement after six months. Nerve grafts and nerve transfers involve splicing or replacing damaged nerves. However, recovery time may last as long as seven years for neck nerves to influence the hand and lower arm. Physical therapy following surgery contributes to the success of the procedures. Many children who have Erb’s palsy may continue to experience weakness and limited use of the affected arm.

Seeking Information
The birth of a child is a joyous occasion that may include less than optimal circumstances. We understand the complications that nerve damage can create, and we can help parents of patients learn how to cope with the consequences. In the absence of reliable information, worry can create stress and anxiety. We are here to alleviate concerns with compassionate consultations.