Brachial Plexus Injury
The bundle of nerves that starts near the neck and shoulder is called the brachial plexus. This important network of nerves controls movements of the shoulder, elbow, wrist, and hand. The brachial plexus has both sensory and motor nerves, the former of which carries nerve impulses to the brain to communicate sensations of pain, temperature and pressure. The latter type of nerves carry instructions from the brain to the muscles to allow for movement.
The highly sensitive brachial plexus is prone to injury especially at the time of birth as the baby’s head and shoulders move through the narrow birth canal. Though the attending delivery room team is well-equipped to troubleshoot a difficult labor and safely bring the newborn into the world, mistakes do happen. When the mistake causes a brachial plexus injury, those present may be liable for the harm caused. A birth injury attorney from Eisbrouch Marsh is prepared to hold those parties liable for medical negligence.
Brachial plexus injuries defined
Brachial plexus injuries occur in about 0.3 to 2.0 births for every 1,000. They are considered a common type of birth injury and are typically diagnosed shortly after birth. This type of birth injury is actually an umbrella diagnosis. There are a few different types of these injuries, including:
- Erb’s palsy (when the upper brachial plexus nerves become injured)
- Klumpke’s palsy (when the lower brachial plexus nerves are damaged)
- Total brachial plexus palsy (when both areas of the nerve bundle is affected)
These types of injuries may also be categorized according to how they occurred. If this type of condition is suspected at birth, the attending physician will perform a physical examination to determine if the limbs are “floppy” and whether the infant has full reflexes. Occasionally, imaging tests, such as x-rays, may be called for.
Common causes of brachial plexus injuries
Birth trauma is the major cause of brachial plexus injuries.
When they occur in older children or adults, the leading causes are:
- High-speed car crashes
- Blunt force trauma
- Tumor (which compresses the nerves)
- Neuropathy (which refers to nerve damage)
- Inflammatory response of the body
When this type of injury occurs upon the delivery of a baby, it is referred to as obstetric brachial plexus palsy or birth-related brachial plexus palsy. When it occurs during birth, it is often the result of a difficult delivery that causes complications with expelling the child’s shoulder from the birth canal. Sometimes, the baby’s shoulder becomes stuck at the mother’s pubic bone. The exertion of force to free the child’s shoulder can cause the brachial plexus nerves to stretch or tear. This is a condition called shoulder dystocia.
About 20 percent of all children affected by shoulder dystocia will experience a temporary or permanent disability. The condition can also affect the health of the mother, leading to complications such as postpartum bleeding and internal lacerations. Healthcare professionals should be prepared to act quickly if shoulder dystocia is exhibited to prevent injury to the child and mother.
Another way in which a brachial plexus birth injury can occur is with the improper use of equipment in the delivery room. For example, if excessive force is used to expel the child from the birth canal, the baby’s neck may be stretched abnormally. This can occur when vacuums, forceps, and similar tools are used improperly or in situations where they are not called for.
Forms of brachial plexus nerve damage include:
- Avulsion — The nerve has been entirely pulled out of the spinal cord; recovery is not possible
- Neurapraxia — The nerve has been mildly stretched or compressed, yet has not been torn; recovery is favorable
- Rupture — The nerve has been stretched and somewhat torn, although the spinal cord attachment is not affected
- Neurotemesis — The nerve itself has been divided; recovery is bleak
- Axonotemesis — The axons – or small components of the nerves – are completely severed; recovery is possible, but not necessarily likely
Symptoms and consequences
It can be very difficult for parents to watch their newborn child suffer from a severe injury through no fault of their own. A brachial plexus birth injury can cause a range of troubling symptoms. The infant is likely to experience pain and muscle weakness. The child may have loss of sensation in the affected limb and paralysis can occur. If the upper brachial plexus nerves were affected, the child will likely have loss of mobility in the shoulder and elbow. If the lower nerves were affected, the paralysis may occur in the hand and wrist.
When the condition is permanent, the child will face ongoing problems and some diminished quality of life. He or she may struggle academically because fine motor skills are affected, causing difficulty with writing and similar tasks. These problems will persist into adulthood, potentially causing difficulties with routine tasks such as driving and performing work responsibilities.
Possible treatment options
In mild cases of brachial plexus injuries, a recovery is expected within three to six months as the nerves repair themselves and regenerate. If a recovery does not occur within this timeframe, parents will need to consider surgical treatment. Nerve grafts and nerve transfers may sometimes be successful. Physical therapy and occupational therapy are always considered for a recovery from this type of injury.
Brachial plexus injury victims have legal rights
Families of children who have suffered brachial plexus injuries and other types of birth injuries must cope with mounting medical expenses, surgical costs, rehabilitative costs, and a plethora of special care needs, including special education and occupational therapy. The legal team of Eisbrouch Marsh understands that no amount of money can truly compensate your family for the disability of your child. However, compensatory damages from a birth injury lawsuit could give you the resources you need to ensure your child’s care for his or her lifetime.
Our attorneys have successfully litigated birth injury malpractice cases for decades. Our in-house investigators can determine what went wrong in the delivery room and who is responsible for your child’s injuries. Contact us today to schedule a free evaluation of your case. We never collect a fee unless we obtain compensation for your family.
- American Society for Surgery of the Hand, Brachial Plexus, http://www.assh.org/Public/HandConditions/Pages/BrachialPlexus.aspx
- LiveScience, Nervous System: Facts, Function & Diseases, http://www.livescience.com/22665-nervous-system.html
- University of Pittsburgh, Brachial Plexus Clinic, http://www.neurosurgery.pitt.edu/centers-excellence/pediatric-neurosurgery/brachial-plexus-clinic
- Johns Hopkins Medicine, Brachial Plexus Injury (BPI), http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/peripheral_nerve...
- MedlinePlus, Brachial plexus injury in newborns, http://www.nlm.nih.gov/medlineplus/ency/article/001395.htm