Each year more babies suffer from brachial plexus injuries than from Down’s Syndrome or muscular dystrophy. But what is brachial plexus, Erb’s Palsy? Who or what may be responsible for the condition to occur in a child?

As New York attorneys who specialize in cases of birth injury, we have seen numerous cases where children are diagnosed shortly after birth with Erb’s palsy or other forms of brachial plexus palsy. We are familiar with the big questions you may have about your child’s diagnosis and have provided the following article to help you understand brachial plexus palsy and the various implications it can have for your child’s health and future.

If your child suffers from Erb’s Palsy caused by a mistake the doctor made, call the Erb’s Palsy attorneys of Oshman & Mirisola today for a free consultation at (212) 233-2100 or use the form to the right and we’ll be in touch with you shortly thereafter.


New York Erb’s Palsy Attorneys

Erb’s Palsy, a Form of Brachial Plexus Palsy

Erb’s palsy also known as Erb-Duchenne Palsy is one of the most common and serious of all shoulder dystocia injuries. Erb’s Palsy is a condition caused by injury to the network of nerves in the shoulder area that carries signals from the spinal cord to the arms and hands. This network, called the brachial plexus, is what the brain uses to control motion and sensation in the arms and hands.

Sadly, injury to the brachial plexus is fairly common during the birthing process, with about 2 children in every 1000 suffering from a birth-related brachial plexus injury.  While not all these injuries result in long-term conditions, each year more babies suffer from brachial plexus injuries than from Down’s Syndrome or muscular dystrophy.

Almost immediately after birth, babies with Erb’s palsy have noticeable limitation in their ability to move the hand or arm on one side of their body. They are unable to form a grip or respond with normal reflexes. In some cases, the baby’s arm will be bent at the elbow against their body.

Depending on the extent of the injury, Erb’s Palsy may be further classified as Erb-Duchenne paralysis or as Klumpke paralysis. Erb-Duchenne paralysis refers to damage to the upper part of the brachial plexus nerve bundle this type of paralysis affects the upper arm completely with some influence on the lower arm. Klumpke paralysis refers to the lower part of the nerve bundle and is usually characterized by paralysis of the lower arm and hand alone, with a tendency for the eyelid on the opposite side of the body to droop.

Erb’s palsy is different from cerebral palsy in that it does not involve damage to the brain. In some cases, Erb’s palsy may be treated through surgery or other forms of medical intervention. While some children’s symptoms of Erb’s palsy go away within a few months, other cases have less success in restoring the affected limb’s functionality. If the symptoms of Erb’s palsy persist past the baby’s initial growth phase, they may develop into muscle atrophy and complete paralysis of the limb.

Erb’s Palsy Birth Injury Attorneys

There are many factors that can contribute to a birth injury resulting in Erb’s palsy, although most of them have to do with excessive pulling or force used during the birth process. It is one of the most common and serious of all shoulder dystocia injuries, a type of trauma which results from a newborn’s shoulder becoming stuck behind the mother’s cervix during delivery. It results in damage to the nerves connecting the arm and shoulder from the use of excessive force or torque by the obstetrician, to release the stuck shoulder of the newborn.

More specifically, when a baby’s shoulder becomes stuck behind the mother’s pubic bone the baby’s head delivers but the shoulders do not follow. This condition is known as a shoulder dystocia. It is one of the most difficult obstacles that can occur during delivery because it carries with it the potential for high risk complications. At this point the physician must perform a particular delivery maneuver avoiding the placement of pressure on the shoulder. If this procedure is done improperly, an Erb’s Palsy can occur where the nerve tissue between the arm and shoulder is stretched, partially torn or completely ruptured.

These nerves are referred to as the “brachial plexus nerves” and emerge from the spinal cord, travel across the shoulder, along the arms, into the hand and ultimately, to the fingers tips. The injury which results to these nerves can cause the shoulder dystocia victim to suffer a potentially permanent, partial or complete paralysis of the arm.

A properly trained obstetrician will identify shoulder dystocia risks and take steps to avoid birth injury during delivery. Increased risk factors include:

1. High birth-weight babies ( >8lbs 14oz)
2. Maternal Diabetes
3. Heavy Mothers
4. Short Maternal Stature
5. A Contracted or Flat Pelvis
6. Pregnancy Beyond 40 weeks
7. Protracted Second Stage of labor

If any of these high risk factors exist, a delivery involving a shoulder dystocia can be prevented by scheduling a caesarean section. Where a shoulder dystocia does occur during birth, one of sixteen different maneuvers taught to obstetricians to free the trapped shoulder can be utilized.

Causes of Erb’s Palsy

Occasionally during labor and birth, a baby’s shoulder can get stuck on the mother’s pelvic bone. This birthing emergency is called Shoulder Dystocia. In this case, doctors must use precise interventional maneuvers to help free the baby by supporting the head of the baby and applying a small amount of traction during dislodging maneuvers. If those methods do not work, the doctor may perform an emergency Caesarean section, use birth assisting tools, or possibly even break the mother’s pelvis.  When the doctor uses excessive traction on the head while the baby’s shoulder remains stuck, the brachial plexus nerves in the baby’s neck may suffer injury. Depending on its location, this injury then causes one of the four types of brachial plexus palsy.

It is important for physicians attending a birth with these risk factors to be aware and exercise all possible caution during the birthing process. In some cases, improper use of force by a doctor or midwife may be to blame for your child’s diagnosis of Erb’s palsy. If the birth is not performed with the proper level of skill and care, or if birthing tools are improperly used during delivery, these errors can have long-lasting consequences to your child’s future.

The use of tools, including forceps or vacuum, to help the baby descend, may increase the risk of shoulder dystocia. Studies also suggest an association between an increased risk for shoulder dystocia and the use of labor-inducing drugs.

Read more: Causes of Injury

Types of Erb’s Palsy

New York Erb’s Palsy DiagnosisThere are different types of brachial plexus injuries. Children with Erb’s palsy are all affected in different ways. The variations are that some children will not have any muscle control or feeling in the arm or hand while some children can move their arms but have little control over the wrist and hand with other children able to use their hands well but can’t use their shoulder or elbow muscles. Depending on the type of nerve damage in Erb’s palsy children the symptoms can range from mild to severe. With Erb’s palsy there are four different types of nerve injuries, including:

  1. an avulsion meaning the nerve is torn from the spine.
  2. a rupture meaning the nerve is torn but not where it attaches to the spine.
  3. a neuroma meaning the nerve has tried to heal but scar tissue has grown around the injury placing pressure on the injured nerve praxis. While the nerve has been damaged, it has not been torn and improvement should be seen within 3 months.
  4. Neuropraxia is the mildest form of a nerve injury. Neuropraxia, the most common form of Erb’s palsy is localized to the specific place where the injury occurs. It is a physiologic block of nerve conduction within an axon without any anatomical interruption. Many infants born with brachial plexus palsy have neuropraxia and sometimes recover within 4-6 weeks.
Read more: Common Types

Symptoms of Erb’s Palsy

Symptoms of Erb’s Palsy are usually very obvious. A baby suffering from Erb’s Palsy will be seen with the affected arm laying by their side and an extended elbow devoid of movement.

The injuries that are associated to Erb’s palsy are the neck, clavicle, shoulder, and arm. Some precautions or problems that should be evaluated for signs of brachial plexus injuries are shoulder or elbow dislocation, a frozen shoulder, soft tissue or joint contractures. Lifting a child with Erb’s Palsy from under the armpits should always be avoided.

Examples of different symptoms of Erb’s palsy can include

  1. No muscle control and no feeling in the arm or hand.
  2. The ability to move but with little control.
  3. The use of hands but not of the shoulder or elbow.
  4. The entire arm may be paralyzed with the hand and fingers hanging limp.
  5. Facial paralysis on the affected side.
  6. Not able to sit up without assistance.
  7. The inability to crawl without the use of therapeutic devices.
Read more: Common Symptoms

Treatment for Erb’s Palsy

Treatment for Erb’s Palsy that does not spontaneously recover generally consists of exercise and physical therapy. In 80% of the babies born with Erb’s palsy recovery will occur without a surgical intervention. Often times, though, a child with brachial plexus palsy can benefit from surgical procedures to increase their arm functions.

Surgery is found to be most effective in Erb’s Palsy children that are between the ages of 5 and 12 months; beyond this age group, surgery will not be as effective. Whether or not surgery is performed is dependent upon the individual child’s condition. Where surgery occurs, it is performed by a pediatric neurosurgeon. The Erb’s Palsy surgical procedure requires special anesthesia, an operating microscope, monitoring equipment, and specialists to be able to expose and identify each of the nerves of the brachial plexus and surrounding structures. Most children with Erb’s Palsy have damage to multiple nerves so more than one procedure must be performed. Erb’s palsy may also be helped by performing daily exercises to both keep muscles limber and to prevent the joints from freezing.

What to Do If Your Child Is Diagnosed with Erb’s Palsy

Depending on the severity of your child’s symptoms, getting the best possible care for your child can present a significant financial burden to your family. If your child was diagnosed with Erb’s palsy and you suspect that it may be the result of birth injury caused by medical negligence, contact the law firm of Oshman & Mirisola. We have fought for the rights of many families just like you to receive financial compensation from the parties who caused your child’s injury.When you are pregnant, you trust your healthcare professional to make the right decisions for you and your baby. If your trust has been violated by a hospital or the physician who attended you, it is your right to receive financial compensation, not only for the additional medical expenses but also for the pain and suffering they have caused you. Our team of New York Erb’s palsy attorneys is ready to fight on behalf of you and your child. Call us today for a no-cost, no-obligation consultation of your case.

If you feel your child suffers from a brachial plexus injury such as Erb’s Palsy and wish to bring legal action to compensate your child for their physical and emotional damages, please contact us and ask for Partner Ted Oshman, or fill out the form below.

Erb’s Palsy FAQs

Cerebral Palsy is a condition involving a group of disorders that affects a child’s ability to control his or her own movement. Cerebral Palsy results from injury to the cerebrum (the largest portion of the brain, involved with higher mental faculties, sensations, and voluntary muscle activities). It can be caused by injury to the brain before, during, or after birth.
Erb’s Palsy/brachial plexus injuries
Cerebral palsy
Shoulder dystocia
Brain injury caused by improper use of vacuum extractors
Untreated jaundice
Brachial Plexus Palsy, also known as Erb’s Palsy, is a condition that affects the nerves that control the muscles in the arm and hand. The brachial plexus, a group of nerves, is located on the right and left side of your neck, between the neck and shoulder area and runs from the spinal cord through the arm to the wrist and hand. Damage to these nerves occurs when a baby’s shoulders become impacted at birth, stretching or tearing the brachial plexus.
Any excess stress to the baby’s neck during delivery may result in injuries to a child’s nerves. This can result in paralysis of the arm, causing it to be limp or dysfunctional. Injuries such as these are classified by severity. Avulsion rupture is when the nerves are torn away at the area of the spine. Neuroma is when the nerves are torn, but during the healing process, scar tissue has formed. This can result in the disabling of the arm. A rupture occurs when the nerves tear at other locations.
There are four types of Erb’s Palsy (brachial plexus) injuries:

An avulsion – the nerve is torn from the spine.
A rupture – the nerve is torn but not where it attaches to the spine.
A neuroma – occurs where scar tissue has grown around the injury putting pressure on the nerve resulting in reduction of signals to the muscles.
Praxis – the nerve has been damaged but not torn.

Erb’s Palsy injuries are treated with a combination of exercise, focused therapy and, in many cases, surgery to correct the damaged nerves. Each treatment plan is unique, based on the child’s severity. An occupational or physical therapist is usually involved in the treatment.
As soon as you suspect that negligence may be the cause of the birth injury in your baby, you should contact an experienced Oshman & Mirisola, LLP birth injury attorney. It is necessary to gather facts and evidence early. There is a statute of limitations for filing medical malpractice claims, so do not delay.
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