Erb’s Palsy

January 20, 2017 | Crandall & Pera Law
Erb’s Palsy

Well what you should know about Erb’s palsy is that it is an injury that occurs, oftentimes in newborns, at the time of delivery. What happens is that when a newborn is coming through the birth canal, at the last moment when the head peaks, unfortunately some children their shoulder will get stuck under the pubis symphysis, which is part of the pelvis, the woman’s pelvis. When that shoulder gets stuck the obstetrician will, or is faced with, essentially, an obstetrical emergency; they have to get that baby out of the birth canal within a relatively short period of time because the time that shoulder is stuck the umbilical chord is also compressed so the baby is not getting oxygen and blood.

What happens then is the doctor has to get this baby out, so they will put the woman, the mother, through a series of maneuvers to try to release that shoulder, it’s the anterior shoulder, and get that baby delivered. In doing so, if the doctor isn’t careful, they can put excessive traction on the baby’s head trying to get the baby out from under the pubis. And when they do that they can cause this angle between your head and your shoulder to be extended and when that happens you can stretch what’s called the brachial plexus, which is a series of nerves, c1 through c6, that innervate your arm and hands and provide the necessary nerves for function and feeling in that part of the body. If you stretch it too far you can tear or completely avulse the nerve from the spinal column, and when we say avulse we mean literally pull that nerve root completely out of the spinal cord. When that happens the child is ultimately delivered, when the child is ultimately delivered, the pediatrician will note that the child’s arm is oftentimes limp or it will turn in shortly after birth and that will tell the pediatrician, uh-oh we have an Erb’s Palsy.

Then they will evaluate the child and will make a decision whether or not that Erb’s palsy is something will resolve, most of them will resolve, it’s just a stretching, but the severe ones, oftentimes where the doctors have put excessive traction on that head trying to get that child out, won’t resolve and that baby will be left with permanent disability, will ultimately require multiple surgeries to try to return the function to the best of whatever they can, but they will never have a normal, completely normal functioning arm.

There’s a whole realm of-- there’s a whole spectrum of injury from mild to very severe and people can ultimately be very deformed as a result of a severe Erb’s palsy. Inevitably, Erb’s palsy is almost always due to a widening of that angle between the head and the shoulder during the birthing process. Almost always, that widening is due to traction by the delivering physician in trying to get the child out. It could also happen, I guess if you used forceps, these big clamps that go around a child’s head, and if a physician pulls too hard on the head, that could happen, or a vacuum, they put a vacuum suction cup on the end of a child’s head and pull it out. But usually, it’s an obstetrician’s hands on a child’s head and they’re pushing down on that head trying to get that anterior shoulder, the upper shoulder, the shoulder that’s pointing up towards the mothers belly button, trying to get that shoulder under the pubic bone. If a woman has a child with Erb’s palsy, they should have somebody look into it. Often times, it’s not due to negligence but if you have an Erb’s palsy, your child has an Erb’s palsy, odds are it was related to traction by a physician.

One final point is a temporary Erb’s palsy, that’s a whole different game, that can occur through mild traction and those almost always resolve on their own. When we’re talking about excessive traction it is usually an avulsion of a nerve. So if a woman has a child and she’s told, “these nerve roots are avulsed in your child and we’re going to have to perform surgery to try to restore the function to your child’s arm the best that we can.” That mother, I would suggest, needs to go talk to an attorney and have somebody look at the care and treatment of that delivery.

Erb’s palsy is just one of several possible results from birth complications referred to as brachial plexus injuries. These injuries, in turn, stem from problems during birth. The proximate cause of Erb’s palsy can range from breech presentation to delayed delivery to shoulder dystocia; in short, the more difficult the birth, the more likely there are to be complications.

Your healthcare providers are responsible for evaluating the position of your baby and the overall chances that a complication will arise well before you go into labor. There are early intervention options to help delivery go as smoothly as possible; doctors can help an infant into a more favorable position for natural birth, or determine well in advance that a Cesarean section is safest for both mom and baby.

Minor brachial plexus injuries involving stretching the nerves, a condition that can heal spontaneously or with minor therapy. Major brachial plexus injuries involve tearing the nerve bundle out of the spinal column; outside of science fiction, there is no way to reconnect severed nerves. A severe brachial plexus injury can cause permanent and irreversible Erb’s palsy.

If medical negligence affected your child’s quality of life, the experienced Ohio and Kentucky medical malpractice attorneys at Crandall & Pera Law can evaluate your case and help get you the compensation you deserve. Call our Kentucky medical malpractice attorneys at 877.651.7764, our Ohio medical malpractice attorneys at 877.686.8879 or contact us today for a free consultation.