Birth trauma refers to damage of the tissues and organs of a newborn baby. Although many newborns might have minor injuries during birth, sometimes the injuries are more severe and include serious nerve damage. Brachial plexus birth injuries refers to damage to the brachial plexus nerves that occurs at birth, and may be related to a difficult labor and delivery.
The brachial plexus is a network of nerves that begins at the spinal cord in the neck and delivers messages from the brain to the shoulder, arm and hand. These nerves control muscle function in the chest, shoulders, arms and hands, as well as sensation in the upper limbs. A brachial plexus birth injury occurs when the baby’s neck is stretched, compressed, or awkwardly twisted. A quick or emergency delivery resulting in the baby being forcibly pulled out can result in a brachial plexus injury. The nerves may stretch or tear during a traumatic delivery. Although nerves have some ability to heal on their own, it depends on the severity of the damage.
The most common type of brachial plexus injury is called Erb’s palsy. Babies with a brachial plexus injury may have difficulty moving their arm or lack feeling in their arm. Damaged nerves may result in symptoms from minor weakness to partial or complete paralysis depending on the severity of the injury. A less common injury that affects the lower brachial plexus is called Klumpke’s palsy. This typically affects only the muscles in the hand and is not common in babies.
Four types of brachial plexus nerve injuries
- Neuropraxia – This is a stretch injury and is the most common. The nerve is stretched but not torn. These injuries will typically heal on their own in time.
- Neuroma – This is a more serious stretch injury that damages nerve fibers and results in scar tissue. The scar tissue may press on the healthy nerve and create discomfort. Long-term recovery is typically only partial, not complete.
- Rupture – This a stretch injury that tears or ruptures the nerve. This type of injury will not heal on its own. Surgery is required to re-attach the nerves.
- Avulsion – This type of injury is the most severe type of nerve damage and occurs when the nerve fiber is torn from the spinal cord.
For severe brachial plexus injuries, prompt surgical treatment might be needed to attempt to regain function. Without it, permanent disability may occur. In the most severe cases, the damage may be permanent. Chronic pain can also be a long-term result of a brachial plexus injury.
Erb’s Palsy birth injury
Erb’s palsy may occur during delivery when excessive pressure is put on the baby’s head, neck or shoulder because of difficulty delivering. The symptoms of brachial plexus injury can vary based on severity and extent of damage. Erb’s palsy is the result of the upper brachial plexus being paralyzed. The risk of a baby developing Erb’s palsy is greatly increased if they develop shoulder dystocia during delivery. Shoulder dystocia is a condition where the baby comes through the birth canal at an awkward angle and a shoulder becomes stuck on the mother’s pelvis. Erb’s palsy can include paralysis or limpness in a baby’s arm, limited or no movement in hands and fingers, and loss of sensation in hands and fingers.
Symptoms of Erb’s Palsy
- Weakness or numbness in arm.
- Limited motion in the shoulder, arm, wrist or hand.
- Arm hanging by side and rotated inward.
- Partial or total paralysis of the arm.
Potential Causes of Erb’s Palsy / Brachial Plexus Injuries
As we mentioned above, brachial plexus nerve injuries typically occur with traumatic or difficult deliveries. This may include a large baby, a breech birth or prolonged labor. A doctor delivering quickly may use excessive force to pull the baby from the birth canal resulting in a stretching of the baby’s neck. This can also result from excessive pulling on the shoulders during a head-first delivery, or by pressure on the infant’s raised arms during a feet-first delivery. Risk factors associated with brachial plexus injuries include improper use of birthing or extraction tools, prolonged labor, breech delivery, large baby, small or abnormal maternal pelvis shape or excessive maternal weight gain.
A baby’s arm that is limp can usually indicate a brachial plexus injury. Proper diagnosis requires a complete neurological exam to determine which nerves have been impacted and the severity of the injury. Treatment may include anything from physical therapy to improve movement in the muscles and nerves or occupational therapy to improve joint function and muscle tone to surgery in the most severe cases.
Brachial Plexus injuries during childbirth
The main cause of Erb’s palsy is damage to the nerves during childbirth. Brachial plexus injuries are avoidable. An obstetrician must proceed with extreme caution when risk factors are present during delivery. For instance, failure to recognize that a caesarean section should have been performed due to the baby’s size, use of excessive force or pressure on the baby’s head, neck, or shoulder during delivery, or improper use of delivery instruments, such as forceps or vacuum extractors, may indicate an error on the part of the doctor.
Often, Erb’s Palsy injuries are the result of preventable medical errors during delivery. Medical professionals have a duty to ensure you and your baby are provided a certain standard of care. Birth injuries may come with lifelong limitations for your child, crippling medical costs, and lasting emotional stress. If your infant has suffered a brachial plexus injury or has been diagnosed with Erb’s Palsy that you believe may have been caused by medical negligence, you should consult with an experienced birth injury attorney to explore your options and help recover compensation for your child’s injuries. The Distasio & Kowalski birth injury attorneys have seen the toll birth injuries can take on a family and we are here to help.