You probably never heard the term brachial plexus injury until your child suffered this injury at birth. It’s incredible, but we have handled many cases where no one told the parents that their child sustained a brachial plexus injury at birth. In these cases, after the baby and mom were released from the hospital the parents noticed that their baby would cry when it’s arm was moved. They would notice the baby was not moving its arm or that the arm was limp. These parents returned to the pediatrician as soon as they could and learned that their child sustained a brachial plexus injury at birth.
You have many questions. What is a brachial plexus injury? How do they occur? What does this injury mean for my child? What types of therapy or surgery will help my child need? We are here to help.
What Is a Brachial Plexus Injury?
The Brachial Plexus is the major bundle of nerves that begins at the base of the neck and run through the shoulder, arm, and hand. These nerves provide for sensation and movement for the upper extremity.
When brachial plexus injuries are caused by medical malpractice, the parents of injured children have the right to hold the at-fault obstetrician, nurse, or other party accountable. Our Phoenix birth injury lawyers are committed to helping children across Arizona get the fair compensation they need for their immediate, continued, and even lifelong care.
Call Cullan & Cullan at (602) 900-9483 today for a free review of your brachial plexus injury claim.
Understanding Brachial Plexus Injuries
Brachial plexus injuries that occur during birth may be called several different things, including simply brachial plexus palsy, neonatal brachial plexus palsy (NBPP), and obstetrical brachial plexus palsy.
Brachial plexus injuries may involve:
- The upper arm (Erb’s palsy – the most common type of injury)
- The lower arm, wrist, and hand (Klumpke’s palsy – less common than Erb’s)
- Both the upper and lower arm (a “total plexus injury” – the least common type)
There are four different types of nerve injuries that may occur (listed from least serious to most serious):
- Neuropraxia, a short-term injury which heals within weeks or months. Here the nerve sustains minor stretching but does not tear
- Neuroma, in which some nerve fibers are stretched and scar tissue may develop
- Rupture, in which the nerve fibers are torn in whole or in part
- Avulsion, most serious type of injury where the nerve is torn from the spinal cord
How Brachial Plexus Injuries Occur
Almost all Brachial plexus injuries occur from the use of excessive force by the doctor or mid-wife who delivered your baby. This most commonly occurs when the baby has difficulty passing through the pelvic opening (“pelvic inlet” in medical terms). Births that involve shoulder dystocia, in which the baby’s shoulder becomes blocked by the mother’s pelvis after the baby’s head has already passed through, are especially likely to result in an upper extremity injury.
Known Risk Factors for Brachial Plexus Birth Injuries
Virtually any condition that may obstruct the baby’s passage down the birth canal is a known risk factor.
Common risk factors include:
- Mothers with an undersized or misshaped pelvis
- Babies that are large (macrosomia)
- Gestational diabetes
- Excessive weight gain by the mother
- Short maternal stature
- Shoulder dystocia
- Prolonged labor – slow dilation or slow descent of baby
- A mother who has history of previous shoulder dystocia or who gave birth to a baby with a brachial plexus injury
- Use of forceps or vacuum extractor
For various reasons, the baby’s shoulder may lodge against the mother’s pelvis after the baby’s head has presented. The medical profession calls this shoulder dystocia, and it is an emergency situation. The most common reason it occurs is that the baby’s shoulders are too broad to pass through the pelvic opening.
If not handled promptly and correctly by the medical team, shoulder dystocia can lead to several potential serious injuries, including brachial plexus injuries. In fact, malpractice suits based on brachial plexus injuries caused by shoulder dystocia have reportedly become the second most common type of obstetrical malpractice claim.
Risk Factors for Shoulder Dystocia
Risk factors for shoulder dystocia largely overlap those for brachial plexus injuries, described above. They include:
- Use of instruments like forceps and vacuum extractors to aid in delivery
- Prior shoulder dystocia birth
- Prolonged second stage of labor
- Induction or augmentation of labor
- Incorrect use of Pitocin
Management of Shoulder Dystocia During Delivery
The most important thing your doctor and nurse can do is be aware of the risk factors for shoulder dystocia or brachial plexus injury and avoid the possibility of a brachial plexus injury from the beginning. Doctors and nurses are taught that they should never pull on a baby’s head - especially when the shoulders are stuck. Sadly, doctors and nurses panic, pull hard on the neck, and apply excessive force that stretches or tears your baby’s nerves.
This brachial plexus injury affects the upper arm. The severity of Erb’s palsy varies considerably, as does the degree of recovery over time. Severe cases can result in paralysis of the upper arm. Pain is common. The affected arm also may also atrophy or grow more slowly than the unaffected arm, leading to a difference in size that continues until growth ends.
Early diagnosis, treatment and therapy are crucial to recovering as much function as possible. Early treatment may involve physical and occupational therapy. If the arm is severely damaged, surgery at a very young age may be necessary to help restore nerve function.
Klumpke’s palsy results from damage to nerves controlling the forearm and hand. As with Erb’s palsy, the severity varies considerably, but even mild injuries tend to cause numbness. In more severe cases, the child will be unable to move the hand and forearm. In those cases, the hand will be “claw-like.”
The degree of natural recovery again depends on how severe the injury is. The affected arm may be temporarily splinted to keep normal alignment. If recovery hasn’t occurred within a reasonable time — generally a few weeks after the injury – physical therapy is employed to improve range of motion, prevent contractures, improve strength, and otherwise minimize deformities. As with Erb’s palsy, complex surgery may be necessary.
Signs of a Brachial Plexus Injury
Symptoms of brachial plexus injury are apparent very quickly:
- Clavicle or collarbone was fractured during delivery
- Failure to move the affected arm is the most obvious symptom.
- Pain or crying when the affected arm is moved
- Holding the arm bent and against the body is also common.
- Weakness in the baby’s grip is also a sign.
When an injury is suspected, the baby can easily be tested to see if the “Moro reflex” is normal. The baby’s head is lifted and released, giving the baby the sensation of falling. The normal reaction is for the arms to swing out away from the body.
In examining the baby, it’s important to determine whether difficulty moving the upper limb is because of a true nerve injury or because the baby is not moving the arm because there is a fracture that causes pain upon movement (known as “pseudo-paralysis”).
Recovering Damages for Brachial Plexus Injuries
The crux of malpractice cases is always whether the medical team acted appropriately — reasonably under all the circumstances – or was negligent in some aspect of their care, causing a birth injury that could have been prevented by appropriate care.
Liability for a brachial plexus injury may stem from the following acts by medical providers:
- Based on the known risk factors for shoulder dystocia, vaginal delivery should never have been attempted
- The doctor and nurse should have been quicker to recognize dystocia when the signs first appeared
- The doctor applied excessive force to the baby during delivery
- Once the delivery was complete, the medical team failed to recognize the signs that a brachial plexus injury had occurred, which delayed therapy and may have exacerbated the nerve damage
If you establish that a medical provider is liable for the brachial plexus injury, the law allows you to recover all damages you have incurred and are reasonably likely to occur in the future, including:
- Past and Future Medical Bills including bills for doctor, physical therapy, occupational therapy, surgery, assistive devices.
- Loss of Income potential; If your child has a severe brachial plexus injury an economist and other witnesses would testify regarding the loss of jobs and income that are available to your child as a result of the injury.
- Non-economic injuries, such as emotional and mental distress, pain and suffering, and other damages to the child and family’s quality of life
- Punitive damages, reserved for the most egregious cases of wrongdoing, meant to penalize the at-fault party
Get Skilled Legal Help for Your Child
Recovering damages for a brachial plexus birth injury requires intimate familiarity with modern obstetrical practices, as well as with the well-known complications that may go wrong during labor and delivery. The cases depend on building a detailed timeline of exactly what happened and when, and what the medical team’s response was. All this has to be ferreted out from voluminous medical records supplemented by interviews of everyone who was present. And it all needs to be done with an eye toward exactly what the law requires in order for a medical practitioner to be held legally liable.
At Cullan & Cullan, we are uniquely qualified and experienced. Our Phoenix brachial plexus injury attorneys are also doctors. A large percentage of our practice for over thirty years has been fighting for children who sustained needless, senseless birth injuries, including brachial plexus injuries.
Contact a Phoenix Brachial Plexus Injury Lawyer
Cullan and Cullan is a nationally recognized birth injury firm. If your child suffered a brachial plexus injury during birth, tell us what happened. Once we know the story we can tell you whether you have a claim and, if so, what the next steps should be. There is no fee for the consultation, and no fee for handling the case unless we succeed in getting you the compensation you deserve.
To get started, give us a call at (602) 900-9483. Caring and knowledgeable help is just a phone call away.