Erb’s palsy claims

The brachial plexus is a network of five nerves, including the four lower cervical nerves (C5, C6, C7 and C8) and the first thoracic nerve (T1). The brachial plexus nerves run down the spinal cord and emerge from between the vertebrae (bones of the spine) in the neck, passing under the collarbone to form the major nerves of the arm. These nerves give movement and feeling to the arm by conducting signals from the spinal cord to the muscles and skin of the chest, shoulder, arm and hand.

Erb’s palsy is one of the names used to describe the upper limb paralysis, weakness, loss of mobility and functional disability which follows an injury to the brachial plexus nerves. Other names for the same condition include brachial plexus nerve injury, brachial plexus paralysis or Erb-Duchenne palsy.

Erb’s palsy birth injury can occur during a difficult or obstructed delivery when the baby’s brachial plexus nerves, which give movement or feeling to an arm, are stretched, bruised or torn by excessive traction (pulling) on the baby’s head, causing weakness or paralysis in the arm.

The severity and duration of the child’s disability depends on the type of nerve damage but can range from mild and short-term to lifelong and severe.

The brachial plexus nerve injury which leads to Erb’s palsy is often caused by negligent care during the delivery of a baby. Excessive traction (pulling) on the baby’s head and failure to use recognised safe techniques to release the baby from its ‘stuck’ position can leave the child with lifelong disability.

There is a greater risk of Erb’s palsy injury when the birth involves:

• assisted delivery using instruments (such as forceps or Ventouse suction);
• a lengthy second stage of labour;
• a large baby;
• excessive maternal weight gain during pregnancy;
• maternal diabetes.

Erb’s palsy or brachial plexus injury is caused when there is too much traction (pulling) on the baby’s head and shoulders during a vaginal delivery.

The risk of injury leading to Erb’s palsy increases where the baby’s head is disproportionately large for the mother’s pelvis. This is known as ‘cephalopelvic disproportion’ and can happen if the baby is big or is incorrectly positioned for delivery, or the mother’s pelvis is small or unusually shaped. If there is a risk of cephalopelvic disproportion, the mother should be warned of the risk of Erb’s palsy during vaginal delivery and a caesarean section may be recommended.

Erb’s palsy can occur if the delivery is obstructed by ‘shoulder dystocia’. This happens when the baby’s head descends into the birth canal but becomes stuck during delivery because one or both shoulders become wedged behind the mother’s pubic bone. The ‘stuck’ baby must be handled very carefully by the midwife or doctor to be delivered safely. Any excessive traction (pulling) on the head during attempts to deliver the baby can cause injury to the baby, including damage to the brachial plexus nerves, resulting in Erb’s palsy.

Erb’s palsy can also be caused by pressure on the baby’s arms during a breech (feet first) delivery.

Boyes Turner have helped recover compensation for clients affected by Erb’s palsy after:

• excessive traction (pulling) and force has been applied to the baby during delivery;
• failure to follow guidance and recommended manoeuvres for shoulder dystocia;
• failure to assess the risks arising from the baby’s weight and size before delivery:
• failure to anticipate and plan for the risk of shoulder dystocia;
• failure to counsel the mother of a large baby about the risks of Erb’s palsy and plan an appropriate method of delivery;
• failure to perform a caesarean section if there are clinical indications to do so;
• failure to recognise and treat maternal diabetes.

The type of Erb’s palsy injury depends on the extent of the damage to the nerves. Identification of the type of nerve injury can help with treatment decisions and predicting the child’s long-term outcome, but Erb’s palsy injuries do not always fit neatly into one category. Erb’s palsy can be caused by:

• neuropraxia – where the nerve is stretched but not torn and often resolves within a few months without treatment;
• neuroma – which involves more serious stretching of the nerves, and may partially improve but leave some long-term damage;
• rupture or tearing of the nerves – a serious injury which needs nerve grafting surgery;
• avulsion – the most serious form of brachial plexus nerve injury, in which the nerve is completely torn away from the spinal cord. Surgery may be possible using healthy nerves from another part of the body.

When a baby suffers a brachial nerve plexus injury, tests should take place as soon as possible to identify which nerves have been damaged, so that any treatment that is needed can be started quickly. If surgery is needed, the sooner it takes place the better the chances of success. Milder brachial plexus nerve injuries may heal, either wholly or partially, without treatment.

Treatment after brachial plexus injury may include:

• physiotherapy to increase arm/shoulder movement and grip strength in the hand;
• occupational therapy (OT) to help with daily activities, e.g. holding or picking things up;
• tendon/muscle release or nerve grafting surgery to repair nerve damage and restore movement in the arm, shoulder or hand.

We have recovered compensation for clients who have been left with permanent disability from brachial plexus and Erb’s palsy birth injury including;

• total paralysis or weakness in one arm;
• numbness in one arm;
• restricted movement and positioning of the arm;
• shorter, smaller sized or different shaping to the arm from reduced bone growth and lack of muscle use;
• limp hand or reduced grip strength;
• drooping eyelid and small eye pupil on the affected side (Horner’s syndrome);
• difficulty maintaining the head in a forward facing position (torticollis);
• arthritis in later life from abnormal wear and tear on affected joints;
• impaired circulation, muscular and nervous development.

Living with Erb’s palsy makes everything more difficult, whether at home, at school or at work, and affects the individual’s ability to participate in some sports and leisure activities.  We work closely with each client, their family and our experts to understand their injury and the restrictions that their disability imposes on their life, so that they receive compensation which eases their hardship and meets their needs.

Our birth injury solicitors have helped clients with permanent Erb’s palsy disability caused by negligent maternity care recover compensation for:

• pain, suffering and disability;
• private medical costs, such as surgery;
• cost of therapies, such physiotherapy, occupational therapy or OT;
• psychological counselling;
• adapted vehicles, specialist aids and equipment, and assistive technology;
• support with special educational needs (SEN);
• necessary home adaptations;
• care and assistance;
• loss of earnings and other financial losses