Erb's Palsy

Erb's Palsy is a nerve injury to the Brachial Plexus nerves. The Brachial Plexus is a group of nerves that run from the spine through the shoulder and to the tips of the fingers. These nerves conduct the signals from the spine allowing the arm and hand to move. Damage to these nerves affects the child's ability to control the muscles in the shoulder, arm, or hand. Your child's disability depends on which nerves are injured and how severely they have been damaged.

Children with Erb's Palsy are affected in different ways. Here are some examples:

• Some children have no muscle control and no feeling in the arm or hand.
• Some children can move their arms, but have little control over the wrist and hand
• Other children can use their hands well but cannot use the shoulder or elbow muscles.

Erb's Palsy symptoms range from a stretching of the nerves with mild limitation of movement and early recovery to a tear of the nerves with complete paralysis and little potential for recovery;

Erb's Palsy (a Brachial Plexus injury) is generally the result of a complication during the child's birth. During the delivery the baby's shoulder may get caught and stretched behind the Pubic Symphysis bone (part of the mother's Pelvis bone). This is known as Shoulder Dystocia. Unless appropriate steps are taken when the shoulder gets stuck, the Brachial Plexus nerves can be compressed, stretched or even torn.

Many babies with Erb's Palsy are larger than average at birth. However, newborns of all sizes, including premature babies, can have these injuries. A larger baby will have a greater chance of getting caught behind the Pubic Symphysis bone and getting injured severely.

About 1 or 2 babies in 1,000 suffer from Erb's Palsy. The symptoms of Erb's Palsy include a limp or paralyzed arm and/or lack of muscle control in the arm or hand.

There are 4 types of Erb's Palsy:

• Stretch injuries vary depending on the amount of stretching. The nerves will often be compressed from swelling and bruising from the shoulder being caught. Stretch injuries are the least severe and will usually recover within 1 to 2 years with nearly complete function.
• Neuroma injuries involve scar tissue compressing the nerves and may require surgery to restore function.
• Rupture injuries involve the nerve being torn at several locations 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. `

Often the diagnosis is more complicated than one of the four groups above. This can occur when different injury types cause the same symptoms making it difficult to know what kind of injury has occured. In addition, sometimes more than one nerve in the Brachial Plexus is injured and the nerves may have different types of injuries.

The treatment plan for your child will be based on the level of the nerves involved and the extent of the damage.

Most cases of Erb's Palsy are mild and most children will recover in 3 to 9 months. The more moderate injuries may take 18 to 24 months to recover. During this recovery time physical therapy may be necessary. Gentle range of motion exercises and electrical stimulation of muscles are be performed regularly as part of a physical therapy program to the muscles and the joints of the arm supple and prevent atrophy. Occupational therapy may also be appropriate.

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

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

Many cases of Erb's palsy are preventable and avoidable. Examples of negligent care on the part of doctors, nurses, and other health care providers that might result in Erb's palsy:

• 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,
• failing to perform apply appropriate procedures in cases involving shoulder dystocia to prevent injury, 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 an Erb's Palsy 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.