Erb’s Palsy or Brachial Plexus Injury Compensation Claims.

There are four different types of Erb’s palsy, classified according to the type and severity of the nerve damage:

• Neuropraxia – This is the most common type of Erb’s palsy; the nerve is stretched or pulled, causing only a temporary problem with the arm. This type of nerve damage typically heals within around three months.
• Neuroma – In cases of neuroma, the nerve is stretched to a point where the fibres break. The nerves will heal, but scar tissue forms, often causing discomfort, and never fully recovering back to normal.
• Rupture – In this type of palsy, the nerve is stretched to the point it is torn in half and will not heal on its own. Surgery is usually required to repair the nerve, and without surgery the arm will likely remain paralysed.
• Avulsion – This is the most serious of all types of Erb’s palsy, and occurs when the nerve is completely torn away from the spinal cord. The nerves within the diaphragm may also be affected, potentially causing difficulty with breathing. The nerve damage could also affect the face, causing the eyelid to droop, which is known as Horner’s Syndrome.

The symptoms of Erb’s palsy will present slightly differently in each baby, depending on the severity of the palsy, but they may experience some of the following:

• The arm is weak, with limited grip strength
• The arm hangs at the side of the body, rotating inwards
• There is numbness in the arm
• There is limited motion within the shoulder, arm, and wrist
• The arm could be completely or partially paralysed
• The normal development of the circulatory and nervous systems, and the muscles could be restricted

Erb’s palsy is primarily caused by a specific type of birth trauma known as shoulder dystocia. This is where the baby’s shoulder becomes trapped behind the mother’s pelvic bone during the birth. If the shoulder dystocia is not detected in time, or if the wrong course of action is taken by the birth team, this can lead to undue stress being placed on the brachial plexus, causing the nerves to strain or tear, and ultimately leading to Erb’s palsy.

As well as the potential for Erb’s palsy to be caused by  negligence, there are also a number of complications and factors which can potentially increase the likelihood of the baby developing Erb’s palsy, including:

• Babies who have a large full-term birth weight
• Mothers who have a particularly small frame
• Mothers who have a small or unusual shaped pelvis
• Mothers with diabetes, either Type 1, Type 2, or gestational
• Mothers who are obese
• Babies who are born in breech position, or another unusual position
• The use of forceps or ventouse during delivery

Erb’s palsy could also be caused by pregnancy injury. For example, if the infant has wide shoulders, once their head has dropped down into the birth canal their shoulder may become restricted by the mother’s pelvic bone, potentially causing the brachial plexus nerves to stretch.

The medical team, caring for you and your baby during pregnancy and birth, are trained to look out for any mitigating factors and to take the appropriate action in order to prevent undue harm to your baby. It is the responsibility of the doctors and midwives entrusted with your care, to advise you of any potential complications and discuss the appropriate birthing options with you. If your birthing options were not discussed and your baby then sustained a shoulder injury, it could indicate clinical negligence.

For example, if the foetal size wasn’t monitored properly and a caesarean section wasn’t performed for a large baby or baby in breech position, this could increase the risk of shoulder dystocia taking place, leading to the baby sustaining nerve damage and potentially developing Erb’s palsy.

If the diagnosis of Erb’s palsy is delayed, it could mean that treatment then becomes less effective. For example, in the case of rupture or avulsion, if surgery is not performed promptly to repair the damaged nerves, it may then be too late to repair them, meaning the Erb’s palsy is likely to be a permanent part of the baby’s life.

In cases where the Erb’s palsy is mild, such as neuropraxia, the baby may recover from their injuries without intervention, although this could take several years. In more severe cases, babies will sadly be left with long-term problems and will require treatment to alleviate the symptoms of the condition.

Surgery can potentially be performed to repair the nerve damage. However, many children will continue to experience some weakness in their shoulder, arm, or hand and will often require regular physiotherapy, massage therapy, or occupational therapy throughout their lives to build strength and improve function in the affected limb.

The long-term prognosis for an baby with Erb’s palsy depends on the severity of damage to the brachial plexus nerves. In some instances, the injury is mild enough that they will make a full recovery within the first few years of life, whilst in other cases the injury will lead to permanent paralysis of the shoulder and arm, presenting lifelong issues and limitations.

Erb’s palsy could limit the child in their early years as they may struggle, or be unable, to take part in certain sports and activities, such as riding a bike, swimming, or doing arts and crafts. In later life, their condition could affect the type of job they are able to do as some jobs require the use of both arms. However, many job roles can be performed effectively with the use of just one arm and workplaces can make adaptations for disabled staff where necessary.

As well as the potential physical limitations throughout life, someone with a disability like Erb’s palsy may experience discrimination or unfavourable treatment in society, which could affect them emotionally and psychologically.

Until fairly recently it was thought that all brachial plexus injuries were a direct result of excessive traction applied by the birth team during delivery of a baby’s shoulders. However, it is now known that shoulder dystocia can actually occur in the absence of excessive force used during delivery. This discovery has influenced the way in which compensation claims for Erb’s palsy are handled.

A compensation claim for Erb’s palsy can only be brought if the condition was caused as a direct result of medical negligence during pregnancy or childbirth. This can include things such as:

• Failure to identify the weight and size of a large baby prior to delivery, particularly in cases where clinical signs or previous pregnancies indicate the likelihood of a large baby.
• Failure to recognise the clinical indications for performing a caesarean section, thus allowing for a vaginal birth despite the potential risks.
• Failure to correctly diagnose and treat gestational diabetes as this often increases the risk of having a baby with a high birth weight.
• Clinical protocol dictates that doctors and midwives should perform certain manoeuvres when a baby is stuck in the birth canal, failure to follow protocol can lead to shoulder dystocia and brachial plexus damage.
• If the birth team applies excessive and unnecessary force or traction to the baby during delivery, which can result in injury.

Around 30% – 40% of Erb’s palsy injuries affect a baby’s posterior shoulder during labour, which is not considered to be due to negligent action by medical staff. However, injuries to the anterior shoulder are, however, more likely to be caused by improper care provided by medical staff. When assessing a medical negligence claim it is important that the position of the baby’s arm is taken into consideration, as this is often the best indicator of whether there is a negligence claim.

If your child’s Erb’s palsy was caused due to negligence during your pregnancy or birth, speak to us today. Our team has the knowledge and experience to handle your claim with the sensitivity and diligence necessary.