Brachial Plexus Palsy

Approximately 1 to 2 babies in 1,000 suffer a Brachial Plexus injury at birth. Many are the result of preventable injuries.

An injury to the Brachial Plexus affects the nerves that control muscles in the shoulder, arm, or hand. Any or all of these muscles may be partially or fully paralyzed as a result of the injury. The extent of your child's disability depends on which nerves are injured and the severity of the damage.

The following are possible symptoms that your child may have a Brachial Plexus injury.

• with less severe injuries
  • numbness and weakness in the arm
• with more severe injuries
  • no muscle control and/or no feeling in the arm or hand
  • little control over the wrist and hand
  • inability to use the shoulder or elbow muscles
  • inability to use the fingers
  • a limp or paralyzed arm

Sometimes a baby's shoulder becomes stuck during delivery. This situation is called Shoulder Dystocia. Unfortunately, doctors, nurses, and other medical staff sometimes panic when this happens and use inappropriate techniques, such as using excessive force to pull on the head. This can result in a brachial plexus injury.

Anticipating the possibility of Shoulder Dystocia and preparing properly for the eventuality is critical. In particular, doctors should carefully consider the impact of risk factors such as,

• maternal diabetes or gestational diabetes
• a large baby
• a history of prior deliveries of large babies or deliveries involving shoulder dystocia
• maternal obesity
• abnormal pelvic size or shape

If the risk of shoulder dystocia is sufficiently high, a C-section may be necessary.

If Shoulder Dystocia occurs during a vaginal delivery, there are a number of different procedures that can be tried, in order, so as to deliver the baby without causing damage to the brachial plexus nerves.

The birth injury is initially diagnosed by means of observation and physical examination of the newborn baby. If initial treatment fails to resolve the limitations caused by the injury, a more comprehensive examination is normally performed by a pediatric neurologist, often between six to twelve months after birth. Twoo of the most common tests that can be performed are:

• Nerve Conduction Study to measure whether the nerves are able to carry an impulse, and if they are, to measure how quickly the impulses travel through the nerve. This test can help identify the nerves involved and the degree of damage to the nerves.
• MRI to visualize the nerves so as to identify any nerves that have been severed and the location of the tear.

There are 4 main types of Brachial Plexus Injuries:

• Neuropraxia or Stretch injuries that range from mild neuropraxia with early recovery to complete paralysis with no potential for recovery, depending on the amount of stretching. The nerves will often be compressed from swelling and bruising from the shoulder being caught.
• Neuroma injuries involve scar tissue (that has developed as the injure nerve has tried to heal itself) compressing the nerves and preventing the nerve from conducting signals to the muscles. This type of Brachial Plexus injury may require surgery to restore function.
• Rupture injuries involve the nerve being torn at several locations (but not at the spinal attachment) and require surgery and therapy to restore normal function.
• Avulsion injuries are when the nerves are pulled from the spinal cord. This is the most severe type of Brachial Plexus injury and requires extensive surgery including a possible muscle transfer to restore function. `

The diagnosis can be more complicated than simply one of the four groups above. For example, several nerves in the Brachial Plexus may be injured and the nerves may have different types of injuries.

The initial course of treatment typically follows a diagnosis made by history and physical examination. At this stage, treatment often consist of physical therapy. If the injury is mild a course of physical therapy may be able to help the child progress or recover from the injury. If therapy does not result in significant progress, especially after six weeks to six months, and evaluation using diagnostic testing reveals a more serious injury surgery may be recommended.

• Nerve Graft replaces damaged sections of nerves with nerves taken from other parts of the body
• Nerve Transfer is used when the nerve root is severed from the spinal cord. Less critical nerves might be hooked into the severed nerve.
• Muscle Transfer may also be necessary if the injury has resulted in muscle atrophy.

In the most severe cases it may take years before the full extent of any permanent impairment can be determined.

Many of the injuries to the Brachial Plexus nerves happen during birth. During childbirth, the shoulder of the baby can get caught and stretched behind the mother's Pubic Symphysis bone (part of the Pelvis bone). If the shoulder gets caught this way, a condition known as Shoulder Dystocia, the Brachial Plexus can be compressed, stretched or torn if excessive pressure is used to try to complete the delivery of the baby.

Below are some examples of negligent care on the part of doctors, nurses, and other health care providers that can result in Brachial Plexus injuries:

• failing to properly estimate the weight of the baby,
• failing to determine that the baby's shoulders are too large to fit through the birth canal,
• failing to recommend a C-section if there is a sufficient risk of shoulder dystocia, and
• applying excessive lateral traction to the baby's neck if shoulder dystocia does occur during a vaginal delivery.

If your son or daughter has a brachial plexus injury and you suspect that the injury resulted because a doctor, nurse, or other health care provider failed to provide adequate care during the pregnancy, or during the labor and delivery of your baby, you should immediately contact an attorney.