Erb’s Palsy

There are many kinds of birth trauma that can give rise to injury to a newborn. Erb’s palsy refers to a devastating injury to the brachial plexus, a network of nerves in the neck that control all the arm nerves. When these nerves are injured, it limits a child’s ability to move and manipulate their shoulder, arm, and hands.

What Causes Erb’s Palsy?

Erb’s palsy occurs when the obstetrician applies too much force when extracting the baby from the birth canal. This could be through the use of forceps or a vacuum extractor, or when a medical practitioner puts too much pressure on the baby’s head while pulling the baby from the birth canal. The baby’s injury occurs to the area where the fifth and sixth cranial nerves meet that join the upper point of the brachial plexus.

The brachial plexus nerves allow for feeling and movement to the child’s arms, hands and fingers. Newborns that have been injured brachial plexus nerves are limited in the movements of their shoulders, upper arms and fingers. Injury to the brachial plexus often times occurs because the anterior shoulder of the infant cannot pass through the birth canal even though the baby’s head has passed. This is referred to as should dystocia. “Dystocia” means a difficult or slow birth.

Shoulder dystocia is one of the most anxiety-ridden emergencies in childbirth. Most times the shoulder dystocia event occurs without warning. Effective management of the emergency requires that the medical providers immediately acknowledge it has occurred and act accordingly in a safe and emergent fashion. That means that the doctors or midwives or nurses maneuver the baby to relieve the impacted shoulder. One such maneuver is the McRoberts maneuver that is designed to relieve the impacted shoulder by internal rotation of the baby. This usually allows for a spontaneous delivery.

Four different types of nerve injuries can cause Erb’s palsy: avulsion, rupture, praxis/stretch, and neuroma. Avulsion is when the nerve separates from the spine completely. Rupture is when there is a tear throughout the nerve itself, but not at the spine. Praxis/stretch is when the nerve is torn, not damaged. And neuroma is when the scar tissue from the original injury puts pressure on the nerve and prevents the nerves from sending messages down the spine.

Risk Factors

Erb’s palsy is typically seen in difficult deliveries. Some risk factors include:

• Previous delivery involving shoulder dystocia, an obstetrical injury that occurs when the baby’s nerves controlling the upper arms are damaged or stretched during delivery ;
• Use of drugs to speed up or induce labor;
• Larger babies, i.e. weighing over 8 ½ lbs. at birth;
• When the mother has a smaller, or unusual-shaped pelvis;
• Breech position or any malposition in the birth canal;
• Either a rapid labor or a prolonged labor.

Diagnosis

Erb’s palsy is typically diagnosed after observing weakness of the arm. Your physician may order an x-ray or other imaging studies to determine if there is any damage to the neck and shoulder’s bones. Also, tests such as electromyologram (EMG) or a nerve conduction study (NCS) can determine whether nerve signals are working properly in the upper arm muscles.

If your child’s condition does not change within the first several months, your doctor may explore surgical options. Regardless of the treatment, every 2 out of 10 babies with Erb's palsy have permanent paralysis in some form. It is a devastating birth injury.

If your child has been afflicted with Erb’s palsy as a result of medical malpractice at a Chicago or Illinois hospital, call Kreisman Law Offices at 312.346.0045 or 800.583.8002 for an immediate free consultation, or fill out a contact form. We will take your call anytime, 24 hours a day. With over 40 years of experience handling birth injury cases, Kreisman Law Offices has the resources and know-how to obtain justice for you and your loved ones.

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