Erbs Palsy - Medical Malpractice LawyersLEGAL HELPLINE: ☎ 855 804 7125
Most families simply don't have the resources to cover all the expenses and provide for a child victim of medical negligence over his or her lifetime. That's where our Erbs palsy medical malpractice lawyers come in to help your child receive the compensation they deserve. We ensure that your child gets a fair deal, by taking the guesswork out of selecting a lawyer. Our medical malpractice lawyers have a track record of successful verdicts and settlements in Erbs palsy compensation claim cases. They only deal with Erbs palsy compensation claims using a contingent fee arrangement which means that if you don't win then they don't get paid. Doctors usually provide a high standard of excellence for their patients however there are occasions when things do go wrong. If your childs condition resulted from clinical negligence, a specialist lawyer can help you assert your rights and get the compensation your child deserves. If you would like legal advice at mo cost on Erbs palsy compensation then just call the helpline or complete the contact form or email our office. An Erbs palsy medical malpractice lawyer, will contact you by telephone to discuss your claim.
Our Erbs palsy lawyers deal with medical malpractice compensation claims throughout Canada. An Erbs palsy medical malpractice compensation claim can result in very high compensation awards due to the potentially serious and long term damage that can be caused. This birth injury affects less than 1% of new born babies and is caused by traumatic injury to the brachial plexus which is a network of nerves that runs from the spine across the shoulder to the fingers. The condition which can result in serious disability is often caused as a result of medical malpractice due to the child being subjected to excessive trauma or traction during labor and delivery. If you believe that your childs condition was caused by a healthcare practitioners negligence, you should contact erbs palsy lawyers without delay. Excessive traction can result in tension on the nerves which may stretch, distend or rupture causing various problems to the newborn child which may include:
- There may be no muscle control and no feeling in the arm or hand.
- Little or reduced control over the wrist and hand
- The hands may be unaffected but use of the shoulder or elbow muscles is restricted.
Erb's Palsy History
Erb's palsy or Erb-Duchenne palsy or brachial plexus palsy involves some aspect of a paralysis of the main nerves of the arm, particularly the nerves that come from C5-C6 in the cervical spine. These nerves form the brachial plexus in the under arm area along with portions of C5-C8 and the thoracic nerve called T1. Almost every case of Erbs palsy in infants occurs because of shoulder dystocia or the shoulder getting stuck during a problematic birth. If the shoulder is tugged in such a way as to damage the nerves of the brachial plexus, paralysis can result.
The first description of a brachial plexus palsy related to obstetrical delivery was described in William Smellie's 1768 treatise on midwifery. The child he described had a condition of bilateral brachial plexus palsy in a newborn who suffered through a difficult delivery.
Then there was Guillaume Benjamin Amand Duchenne, who in 1861 came up with the term obstetrical palsy of the brachial plexus. He looked at 4 infants who had nearly identical arm limitations that stemmed from birth. In 1874, Wilhelm Heinrich Erb did a treatise explaining the palsies of adults who had brachial plexus palsy from birth. He also identified that the lesion was at the level of C5 and C6 and denied that the problem was from an isolated peripheral nerve lesion.
Erbs Palsy Cause
The main cause of Erbs palsy is shoulder dystocia, when the doctor pulls hard on one side of the fetal head in an attempt to slip a shoulder out of the birth canal. The head and neck are pulled to one side but the shoulders stay lodged in the birth canal so that there is excess tension on the nerves going from the cervical spine to the upper arm.
The condition can happen with a breech delivery in situations where the infants body is out but the head is stuck. Unnatural pulling on the arms can stretch the neck and can result in damage to the brachial plexus.
Surprisingly, Erbs palsy can happen in a non-neonate whenever there is trauma to the head and shoulder with stretching of the nerves in the brachial plexus. Direct violent actions, like gunshot wounds and an assault with traction on the arm can cause Erbs palsy. A doctor trying to reduce a dislocated shoulder can damage the brachial plexus and can cause Erbs palsy to occur.
Erbs Palsy Appearance
Erbs palsy is a weakness or paralysis of part of the arm or the entire arm. The degree of arm paralysis depends on which nerves were injured and to what degree. For example, when just the upper arm is effected, doctors call it a brachial plexus injury. If both the upper and lower part of the arm is affected, doctors call it Erbs palsy. If it affects the upper arm, the rotating aspect of the lower arm and the hand, doctors call it Klumpke paralysis. In this condition, the eyelid can droop on the eye opposite the side of the hand injury.
The arm paralysis can be complete or only partial. Each nerve root can be torn or just bruised. The most common nerve root involved in Erbs palsy is C5, which is actually the connection between C5 and C6. It is the furthest point from the area of traction so that it gets the greatest amount of stresses placed on it. It is characterized as a lower motor neuron disease.
The nerves that are most commonly followed include the axillary nerve, the musculocutaneous nerve, and the suprascapular nerve. The child most likely will lose sensation in the affected arm and have paralysis of the arm, along with atrophy of the deltoid, the biceps and the bracialis muscles. The arm usually hangs by the side of the body and is rotated inward or medially. The forearm is completely extended and is pronated. The arm is unable to be abducted from the side of the body and the elbow flexion is completely lost. There is no supination ability in the forearm. In other words, the hand cannot be rotated palm-side up.
Children who are affected as an infant or newborn may have stunted growth from the shoulder to the fingers. Circulation and muscle function are completely impaired along with the nerve damage. They often can't raise their arm above shoulder height, even though they technically have the nerves to do so in many situations. There won't be any ability to regulate the temperature of the affected arm, which makes the arm cold and sometimes unreasonably cold in the wintertime. The child needs to be carefully watched when the weather is cold. In addition, wound healing is slow in these children because of a lack of normal circulation and they often get infections of wounds.
The worst problem in Erbs palsy is a lack of nerve function due to permanent damage to the nerves. The most anesthetic area is the area between the shoulder and the elbow. Some children have total loss of anesthesia of the entire arm.
Erbs palsy can cause severe disability and may be as a result of medical malpractice that allowed the child to be subjected to excessive trauma during labor or delivery. Erbs palsy is caused by an injury to the brachial plexus which is a network of nerves that run from the spine through the shoulder to the tips of the fingers. An Erbs palsy medical malpractice lawyer may be able to claim substantial compensation for this injury which can cause varying degrees of paralysis of the hand, arm or shoulder.
Damage to the brachial plexus nerves falls into three main clinical categories :-
Neuropraxia is the mildest and most common form. Many infants born with brachial plexus injuries have neuropraxia and often recover spontaneously over a short period of time.
Axonotmesis nerve damage causes a complete absence of sensation though recovery is fairly good.
Neurotmesis is the greatest degree of nerve injury and one or more of the nerves in the brachial plexus may be affected. The prospects of recovery are poor.
There are well known risk factors relevant to both the unborn child and the mother which any doctor or attending healthcare professional should be aware of including;
- Maternal diabetes
- Unusually large child
- Excessive force used to facilitate delivery
- Failure to manage shoulder dystocia
Children with this condition are affected in different ways and the amount of compensation that a lawyer can recover in an Erbs palsy medical malpractice case is dependent on the severity, duration and degree of the disability. There may be no muscle control or feeling in the arm or hand or little control over the wrist and hand. Some children are able to use their hands well but are unable use their shoulder or elbow muscles. Symptoms can range from mild to severe and temporary to permanent and are caused by four main different types of nerve injury which are :-
Avulsion where the nerve is torn from the spine
Rupture where the nerve is torn but not at the point of attachment to the to the spinal cord
Neuroma where scar tissue has grown around an injured nerve causing the exertion of pressure on the nerve
Praxis which is nerve damage falling short of a tear or rupture with improvement of function usually within 3 months
Brachial plexus injury is classified according to the type and extent of nerve damage as follows;
Klumpke's Palsy characterized by a limp hand and immobile fingers often associated with Horners syndrome which is caused by damage to the sympathetic nervous system.
Complete Brachial Plexus Palsy is characterized by paralysis of the entire arm often associated with Horner's Syndrome and Torticollis.
Erbs Palsy is characterized by the arm being turned towards the body, with a stiff elbow and the hand in a ‘waiters tip’ position.
Most brachial plexus injuries are as a result of failure to manage shoulder dystocia which may occur during labor when the baby's shoulder gets trapped behind the mother's pelvic bone. There are well established protocols to deal with the problem and failure to follow recognized guidelines may result in severe injury or death. Medical malpractice claims instigated by erbs palsy lawyers for brachial plexus injuries usually fall into two main categories;
- negligent handling of shoulder dystocia - failure to follow established protocols
- failure to arrange a c-section in appropriate cases
Because the cause of Erbs palsy is something that generally happens at the time of birth, it is usually diagnosed shortly after birth. What isn't known at the time of birth, however, is the extent of the disease when the first year rolls around. The babies with Erbs palsy do not have a Moro reflex on the side of the injury. This occurs by startling the infant and seeing the arms extend outward and upward. The affected arm does not extend as much and the palms are upward and the thumbs are flexed.
Some babies with Erbs palsy hold the affected arm tight against the body and will hold the elbow flexed. There may be no grip strength on the affected side and the arm will grow to become smaller than the unaffected side.
If a child is diagnosed with visible signs of Erb palsy by the age of one year, these symptoms are likely to be permanent with no appreciable improvement in the symptoms of the disease.
Simple stretching injuries of the cervical nerves will result in healing that occurs spontaneously by the time the infant is 6-12 months of age. Parents should do gentle massage of the affected arm and should do gentle range of motion of the arm so the arm doesn't get arthritic or frozen. Physical therapy can be done in order to keep the muscles of the upper and lower arm strong until strength returns on its own. Nerve injuries heal more slowly than, say, muscle injuries or other soft tissue injuries. Even if the child receives a tendon transplant, healing does not occur for another two years and, in some cases, there is prolonged injury and weakness to the affected extremity. Both strength and range of motion are permanently impaired.
While it's true that some babies get better from Erbs palsy on their own, other babies need physical therapy or other intervention to restore the functioning of their nerves. A neonatal specialist in pediatric neurosurgery may be necessary for situations where there is an avulsion fracture of the nerve. The nerves can be put back together and can slowly gain function. Children often recover by the time they reach their first birthday; those who have not completely recovered by this time rarely gain any functionality in their arm and develop secondary arthritis.
There are three main treatments for Erbs palsy. The first one is a nerve transplant taken from the opposite leg that can help connect nerve ends to nerve ends. The second one is a subscapularis release, which takes the tension off the damaged nerve. The third is whats called a latissimus dorsi tendon release.
Nerve transplants are done on infants of age 9 months or younger. If they are done on children older than this, it can cause more harm than good and nerve damage can occur from the transplant site. There can also be scarring along the neck and shoulder that can be quite hideous in a child older than age 9 months.
Subscapularis release surgery can be done at any age. The surgeon simply performs a Z shaped incision into the subscapularis muscle to let the muscles stretch better. The strength and functionality of the muscle can be compromised in this type of procedure.
When the doctor does the latissimus dorsi tendon transfer, the latissimus dorsi muscle is cut in half horizontally and each end is pulled around in order to attach it to the outside of the biceps muscle. It allows the arm to externally rotate better. It has only a certain degree of success. There may be increased sensitivity in the biceps area where the latissimus dorsi is attached because there are excessive numbers of nerve endings in the area.
Erbs palsy is most often due to stretching of the C5 and C6 cranial nerves and fortunately, most cases of this condition resolve spontaneously by the time the child reaches 6-12 months of age. Stretching exercises shock the nerves into working again but it can occasionally cause scar tissue to form around the nerve. In such cases, recovery may not be complete. If the nerves are torn, this is the most serious case scenario and there may not be any healing at all without surgical intervention. In rare situations, the nerve is avulsed or torn off the spinal cord and won't heal without intervention. Fortunately, fewer than 10 percent of Erbs palsy cases at birth go on to result in a permanent paralysis or loss of sensation of the arm.
Erbs Palsy Malpractice Overview
Erb's palsy is the most common nerve injury to infants. It occurs at the time of birth when the doctor pulls too much on the fetal neck, stretching and damaging the nerves of the brachial plexus. This is why it is also called brachial plexus palsy. The end result is weakness or paralysis of the baby's arm on the side the neck and shoulders were pulled on too much. The cause of the disease is shoulder dystocia or having the shoulder stuck at the outlet of the birth canal. The fetal head is born but the shoulders are stuck in the birth canal. Pulling on the neck results in the pulling of the nerves in the baby's armpit area, resulting in Erb's palsy. Failure to follow accepted protocols that results in nerve damage can give rise to a substantial compensation claim by Erbs palsy lawyers.
There are several different forms of Erb's palsy and it all depends on the location of the problem in the nerve plexus called the brachial plexus. Nerves that affect only the lower arm or the upper arm can be separately affected and there is a condition known as Klumpke paralysis, which involves damage to the nerves affecting the baby's hand. There can be drooping of the eyelid on the opposite side of the injury to the arm.
Symptoms are usually seen immediately after the birth of the child. The usual Moro reflex is diminished on one side of the body in the arm and the arm is held flexed at the elbow, tightly against the body. The grasp is minimal at the time of the birth of the baby and spontaneous movement is lacking on the affected side of the body at the level of the upper arm, the lower arm or the hand.
The cause of Erb's palsy or brachial plexus injuries is difficulty in delivery of the baby. The head can be of a normal size and may deliver relatively easily. It's when the shoulders are supposed to be delivered that the problem occurs. The natural response of the doctor is to pull on the head in different directions to get the shoulders out. Too much pulling yields damage to the brachial plexus. It can happen in a breech delivery when the body is out but the shoulders get stuck. The doctor in this case pulls too much on the upper arm to deliver the head. This stretches the brachial plexus and damages the nerves. Breech deliveries are one risk factor for Erb's palsy. Another risk factor is shoulder dystocia, which means "stuck shoulders". The practice of cesarean section for large or breech infants has made for a much less risk of Erb's palsy in most deliveries. Instrumentation can cause brachial plexus palsy and these fortunately are not used as much today as they used to be used.
You can diagnose Erb's palsy and other types of nerve injuries to the brachial plexus by carefully examining the infant's arm, including the Moro reflex examination. If there is pseudoparalysis or weakness of the arm but not paralysis, you will still see a Moro's reflex. Pseudoparalysis of the arm is actually a fracture of the clavicle or arm that makes movement painful so the infant doesn't use the arm very much. If there is Erb's palsy, you will see a floppy arm on the affected side.
The treatment of Erb's palsy involves gently massaging the affected extremity and doing mild range of motion exercises in order to help the nerves come back to life. It takes about three to six months to see a resolution of Erb's palsy using this method but if it does not occur, the surgeon must do surgery to reconnect the nerves in the armpit. Tendon transfer can be done to help the arm work better if nerve surgery fails. Most infants fortunately recover by the age of six months but if there is not recovery after six months or after surgery, the infant is likely to have some residual paralysis of the affected arm for the rest of their lives.
Doctors can prevent Erb's palsy by predicting which infants will be too large to pass through the birth canal and do a caesarean section on those infants. X-rays or ultrasound can do the prediction of the size of the baby.
Erbs Palsy Lawyers
To succeed in a claim for compensation it is necessary for erbs palsy medical malpractice lawyers to show that it is more likely than not that their client has suffered injury which they would not otherwise have suffered but for negligent treatment by a health care professional. Treatment is negligent if a healthcare provider has fallen below the minimum standard of skill or care that the medical profession regards as reasonable in that particular area of the country. This includes not only doctors but also hospitals, clinics, dentists, nurses and technicians and any other party or body that undertakes to provide services to take care of patients sufficient to establish a duty of care. A doctor/patient relationship is usually sufficient for erbs palsy lawyers to establish the existence of a duty of care.
Our Erbs palsy lawyers can help you to exercise your legal rights to obtain the medical malpractice compensation that your child deserves. Our Erbs palsy lawyers will deal with your claim using a contingency fee arrangement which means if you don't succeed in receiving compensation then your lawyers won't get paid. You will receive a complete professional service from lawyers who specialise in claiming compensation for personal injury caused as a result of clinical negligence. For advice at no cost without obligation just complete the contact form and a qualified lawyer will telephone you immediately to discuss your compensation claim without further obligation.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here