Erb’s Palsy

Erb’s palsy, a obstetric brachial plexus disorder, results from injury of nerves in an infant’s upper arm, which suffers damage during the birthing process. Parents may notice right away there is a problem, as the baby’s arm hangs limp from the shoulder, while the wrist and fingers may be awkwardly bent.

Depending on the severity of the injury, the long-term effects of this condition can range from mild to serious, with a range of weakness or loss of movement in the upper arm. Many babies recover within six months or so. However, some suffer permanent, partial or total loss of function in the arm.

Boston birth injury attorneys at Jeffrey Glassman Injury Lawyers know that in many cases, the condition is the result of poor obstetrical care.

The American Academy of Orthopaedic Surgeons reports that 2 of every 1,000 babies will be diagnosed with Erb’s palsy.

The basic cause of the condition is when a child’s neck is stretched to the side. This usually occurs as a result of shoulder dystocia during a difficult birth. This is a condition wherein after a vaginal delivery of the child’s head, the shoulder nearer to the front can’t pass below the pubic midline cartilaginous joint – or at least not without significant manipulation.

Typically, the injury happens at the area of the baby’s neck where the fifth and sixth cranial nerves merge to create the top part of the brachial plexus. These are the nerves that give feeling to the arm, hand fingers.

Another possible cause of Erb’s palsy is when a child is delivered from a breech position. In this scenario, the infant’s arms may be forcefully pulled backward over the head as the doctor pulls the baby by the legs.

Similar issues may also cause a condition known as Klumpke’s Palsy, which involves injuries to different nerves in the back and neck, and result in weakness or paralysis in the hand and fingers.

There are also rare situations in which Erb’s palsy can result in a cesarean section birth. A 2005 study published in the journal Medical Law Review noted only two cases out of 300 in which this happened. One was the result of manual replacement of an already-delivered head into a pelvis after forceps and vacuum procedures failed. Another involved extensive adhesions in the mother’s abdomen that resulted in a limited space for the incision and extraction. Lateral traction is usually the cause in these cases.

According to research published in the journal Paediatrics & Child Health, the primary risk factors for the condition include:

• Large fetal size
• Maternal diabetes
• High maternal weight
• Small maternal size
• Infants in breech position
• Shoulder dystocia
• Difficult delivery
• Mothers who have labor induced with drugs, such as Pitocin

Signs of Erb’s palsy include:

• A limpness of one arm, which may also be bent at the elbow joint or held against the body;
• Decreased ability or inability to grip with one hand;
• Full or partial paralysis;
• Numbness in the arm;
• Impaired muscular development.

In some cases, the injury is obvious soon after birth. However, if the condition is not severe, it may not be noticed right away.

Parents whose child has received this diagnosis should seek legal advice. Understand that not all diagnoses of Erb’s palsy will be grounds for litigation. That’s because despite the injury, the doctor or other health care professionals may have acted reasonably under the circumstances. But most patients have no way of knowing that unless they raise the issue with an experienced injury lawyer.

Erb’s palsy is generally recognized as a condition that probably was preventable with appropriate medical care. But determining this for sure is a complex matter.

Doctors, midwives and other health care providers are not necessarily responsible for poor outcomes. The question is whether they adhered to the accepted standard of care.

Plaintiffs in these cases must prove:

• Doctor owed a duty of care (i.e., had a doctor-patient relationship with plaintiff);
• Doctor breached that duty by failing to act as other reasonable professionals in his or her field would, given the circumstances;
• That breach of duty caused injury to mother or child.

Physicians are trained to be attentive to certain risks, both in advance of childbirth and during. When a baby is unusually large, or the mother is overweight or the delivery is especially difficult, they should know there is a chance these factors could contribute to the risk of shoulder dystocia. The appropriate response to this risk may vary, but it could involve recommendation of an alternative cesarean section.

Even where no risk factors are present, health care providers could be negligent in:

• Failing to react appropriately to problems as they arise;
• Pulling too hard on the baby’s head;
• Using too much force in the use of vacuum or forceps.

Treatment for Erb’s palsy usually involves physical and occupational therapy. In severe cases, surgery may be necessary. Even then, the child may suffer long-term effects.

If your child has been diagnosed with Erb’s palsy in Boston or elsewhere in Massachusetts, call us today to learn more about your options for compensation.