Erb’s Palsy is a birth injury that may occur as a result of medical malpractice. It is a type of brachial plexus palsy. The brachial plexus is a group of nerves originating near the neck and shoulders and traveling down the arm. This group of nerves controls the muscles of the shoulder, arm and hand.
Sometimes, brachial plexus injuries occur during child birth, particularly when excessive traction is used on the baby’s head or neck during delivery. Some brachial plexus injuries are more severe than others.
Erb’s palsy results from damage to the upper group of nerves. A child with Erb’s palsy generally has an arm that is rotated toward the body. There is weakness or paralysis of the arm. Sometimes there is a loss of sensation. The affected arm may also grow more slowly than the uninjured arm, resulting in size differences.
Severity of Erb's Palsy Birth Injury
The injury is usually the result of resolving a shoulder dystocia during surgery. Shoulder dystocia occurs when the fetal shoulder becomes lodged behind the maternal pelvic bone. As the physician twists and pulls on the baby, the nerves stemming from C5 – C6 (called “Erb’s point”) are injured. The degree of injury ranges from mild trauma to complete severance. There are three general categories of injury severity:
Neuropraxia is the most common type of nerve injury, and it is the mildest. It is usually caused by an excess of pressure on the nerve or stretching, which results in injury and swelling. With neuropraxia, the axis and the sheath of the nerve remain intact. However, nerve conduction is blocked. Neuropraxia generally resolves on its own as the nerve heals. The length of time for recovery could be hours or it could be months, depending on the severity.
Axonotmesis means that the nerve axons have been damaged such that they are no longer completely intact. For the injury to heal, the axon must regrow. Sometimes, scar tissue forms which interferes with regrowth. These injuries take longer to heal – at least several months. If scar tissue is present, surgery may be needed to aide with healing.
Neurotmesis is the most severe nerve injury. With neurotmesis there is a complete severing or rupture of the nerve. Surgery is required, and this nerve injury will not heal spontaneously.
Risk Factors For Erb's Palsy Birth Injury
Sadly, many brachial plexus injuries could have been prevented. There are risk factors for shoulder dystocia. When these factors are present, the shoulder dystocia and resulting injury could have been prevented by performing a C-section. Here are the most common risk factors:
- History of shoulder dystocia in prior delivery
Fetal weight greater than 4,000 g
Maternal weight gain greater than 35 pounds
Number of prior pregnancies carried to a viable gestational age
The treatment of Erb’s palsy depends on the severity of the nerve injury. Many times, minor injuries resolve spontaneously. Physical therapy can help resolve mild nerve damage. Therapy is directed not only at resolving the nerve injury, but also increasing range of motion and muscle strength while the nerve heals. Gentle massage can help. The physical therapist will teach you how to properly massage your baby and move his or her arm.
If the nerve has not healed within about 3 – 6 months, your doctor might recommend surgery. There are several surgeries. One is called nerve grafting. A section of healthy nerve is transferred to the injured area to prompt regrowth. Another type of surgery is called nerve decompression. That is a minimally invasive procedure where a tool is used to decompress the nerves.
The prognosis depends on the severity of the injury. Mild cases generally resolve completely with no long term complications. In fact, between 70 and 80% of cases fully resolve within a year with appropriate treatment.
Other times, the child could have functional loss and muscular limitations. The affected arm may grow slower than the unaffected arm, resulting in size differences. Care must be taken to help children permanently affected by Erb’s palsy develop self-esteem and teaching them to compensate for any limitations.
We Can Help
If your child suffered an injury during childbirth, such as a Erb’s palsy, and is now dealing with complications related to that injury, it is important to explore his or her legal rights and see if there is a valid medical malpractice claim. Birth injury litigation can be complex; we have a network of professionals, from medical experts to financial experts. Please contact Hoffer & Sheremet, PLC by completing our free consultation form, calling us at 616.278.0888, or emailing us to learn more about compensation to which your child may be entitled.