Neonatal brachial plexus palsy (BPP), also known as Erb’s palsy (or Duchenne-Erb’s palsy), is a serious condition that can effect newborns as a result of accident or medical negligence at birth. The brachial plexus is a collection of nerves (called the ventral rami) which runs from the spinal column through the neck, behind the collarbone, and through the shoulder area into the arm, and which feed into and control the muscles of the arm. Various studies have found that between 1 and 4 infants per 1,000 born in the United States suffer from brachial plexus palsy.
An infant with brachial plexus palsy can experience anything from mild effects to full loss of function and sensation in the affected arm. This can leave the victim with an arm that is flaccid and cannot be moved at all, or can be moved only partially.
Brachial plexus palsy most often occurs in difficult births, especially those where the attending physician chooses to use forceps or a vacuum extractor. Brachial plexus injury is thus uncommon when a baby is delivered via cesarean section: less than 1% of BPP cases occur in c-section deliveries. Moreover, brachial plexus palsy is far more common in larger infants – infants weighing more than 5 kilograms (or 11 pounds) at birth (which, indeed, often corresponds to a difficult delivery).
Based on this fact, in 2002 the American College of Obstetricians and Gynecologists began recommending that infants projected to weigh 5 kg or more be delivered via cesarean section. Because such large babies are relatively rare, but BPP occurs in up to twenty percent of these infants, such a practice would have little effect on the c-section rate, but a large effect in reducing BPP rates.
Much to the consternation of the birth injury attorneys of Passen & Powell, however, this recommendation has not been widely adopted. In fact, in addition to the many obstetricians who do not routinely evaluate the projected weight of the infant prior to labor or delivery, many other obstetricians continue to ignore this recommendation even when all the indicators of a high projected birthweight are present.
A physician who does not recommend a c-section in such a case, or at least present the mother with the information available concerning the risk of BPP, may be guilty of medical malpractice if the infant is then a victim of BPP. Indeed, according to the Data Sharing Project (a database of medical malpractice claims maintained by the Physician Insurers Association of America) nearly 60% of lawsuits related to BPP result in a monetary payout.
In addition to injury during birth, very rarely the injury can occur in utero, prior to labor. Such injuries can usually be identified by the size of the affected arm, shoulder, and pectoral muscle – in pre-labor brachial plexus palsy, the injured arm is usually smaller.
The severity of the effects of BPP in any particular case is determined by the extent of the injury to the brachial plexus during birth – the number of nerves within the plexus that are injured, and how extensive the injury is to each nerve.
The longevity of the consequences of brachial plexus palsy can vary wildly. In some cases, the effects are short-lived. Some infants with BPP recover within a week of birth, and regain the full, normal function of the effected arm. Other infants, however, can suffer from permanent weakness of the affected arm and shoulder. If an infant’s condition does not improve in the first two weeks after birth, it is highly likely that she will not make a full recovery. These infants, up to 25% of those who suffer from BPP, can have mild to severe long-term or even lifelong disability.
Brachial plexus palsy can also occur in adults and older children. The causes, results, and likely outcome, however, differs greatly. While BPP in infants is generally caused by a “slow traction” injury, in other victims the cause is generally a “shearing,” or rapid trauma, which generally leads to the more sever forms of BPP. And, unlike infants, there is little to no chance of recovery when the injury occurs in an older child.
Treatment for brachial plexus palsy is similar to that of cerebral palsy, another common form of disability from birth injury. Children with continuing problems from BPP receive physical and often occupational therapy, and must regularly engage in a prescribed exercise program at home.
In a small number of cases, BPP patients can receive some help from surgery, performed in the early stages of BPP, designed to increase innervation in the injured area. A similarly small number of those affected can be helped by a tendon transfer surgery on the shoulder, or occasionally elbow. Other unconventional but sometimes helpful treatments can include such things as electrical stimulation, or even treatment with botulinum toxin (commonly known as botox).
For a free consultation with an experienced Chicago birth injury attorney at Passen & Powell, call us at (312) 527-4500.