BY: Matthew Curtis | IN: Birth Injury, Medical Malpractice
A difficult labor and delivery can result in birth injuries that cause long-term damage. One common result is neonatal brachial plexus palsy (NBPP), which occurs in approximately one to three births per 1,000.
The brachial plexus is a complex network of nerves running from the spinal cord to the neck and shoulders. These nerves control muscle function in the chest, shoulders, arms, and hands, as well as sensation in the upper limbs. In adults, brachial plexus injuries can be caused by stretching or tearing the nerves during contact sports.
During childbirth, a baby’s brachial plexus nerves can be stretched, compressed, or torn. This can cause reduced muscle function or arm paralysis. Brachial plexus palsy most often affects only the upper arm; this type of palsy is called Duchenne-Erb, Erb-Duchenne, or just Erb’s palsy. If a child’s lower arm or hand is impaired, the condition is known as Klumpke paralysis; this type is much less common. Whole-arm paralysis or impairment is called “global” palsy.
The most minor form of brachial plexus injury is called neuropraxia, where the nerves are stretched but not torn. A severe stretch may result in a neuroma, where the stretching damages some of the nerve fibers enough to cause scarring and permanent impairments. A rupture, or tear, is the most serious, especially when the nerve is torn completely away from the spinal cord (called an avulsion).
One of the most common causes of brachial plexus birth injuries is traction to the child’s neck during delivery, caused by an obstetrician pulling with his or her hand or using instruments like forceps or a vacuum. Certain factors increase the risk of these injuries, including a larger-than-average baby, breech (feet down) presentation, maternal diabetes, or prolonged or complicated labor. Shoulder dystocia is one specific kind of birth complication; after the delivery of the baby’s head, the anterior shoulder of the infant becomes stuck, requiring significant manipulation or force to overcome. This increases the chance that the baby’s nerves will be stretched or pulled, causing injury.
An infant’s arm that is limp or unusually stiff can indicate a brachial plexus injury. Proper diagnosis requires a complete neurological examination by a specialist to determine which nerves have been affected and the severity of the injury. A nerve conduction study (NCS) may be used to identify the extent of the nerve impulses transmission impairment, and an electromyogram (EMG) may be performed to reveal the extent of muscle damage caused by the nerve injury.
Minor brachial plexus stretches or strains may heal on their own, but physical therapy is recommended for more serious injuries. This involves daily physical therapy and range-of-motion exercises, done as often as possible throughout the day, beginning when a baby is about three weeks old. The exercises help maintain the range of motion in the shoulder, elbow, wrist, and hand and help prevent the joint from becoming permanently stiff, a condition called joint contracture. If physical therapy does not stimulate improvement over a child’s first three to six months, your doctor may suggest surgical options like a nerve graft or nerve transfer. Treatment can be frustrating, time-consuming, and costly. Even surgery, unfortunately, does not usually restore full, normal function to the affected areas, which can lag behind the others in growth and strength.
Doctors and treating providers should exercise caution when planning a delivery if risk factors are present. Pregnant women should be tested for gestational diabetes because this condition correlates with larger babies and higher chances of brachial plexus injury during delivery. Attentive care during labor and delivery is essential to improve the chances of a healthy birth. Any excessive downward traction during the delivery process must be avoided in order to prevent injury to the brachial plexus nerves.
If your child has suffered brachial plexus birth injuries that you believe may be caused by negligence or medical error, consult with an attorney who is experienced in birth injury and medical malpractice law. The skilled, sympathetic attorneys at Sommers Schwartz will help you evaluate and pursue your options and help you recover what you deserve for your child’s injuries.
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Matthew Curtis is a senior shareholder and member of the Board of Directors at Sommers Schwartz, P.C. For the past 30 years, he has successfully litigated complex personal injury and medical malpractice cases throughout Michigan, and across the United States.