Brachial Plexus Palsy

What is Brachial Plexus Palsy?

Brachial plexus palsy occurs when the nerves of the brachial plexus, muscles located between the neck and shoulder, are stretched, compressed or torn during childbirth. Nearly three out of every 1,000 births result in a brachial plexus injury. In some cases, when the nerves are stretched only slightly, the injury can heal on its own or with daily physical therapy within a short period. Other injuries, however, can result in a loss of muscle function, or even paralysis of the upper arm. About one in 10 cases requires surgery and long-term medical care. In the worst of cases, a child might not ever fully regain function of their shoulder, arm, wrist or hand.

Causes

The injury is most likely to occur when the baby’s shoulders are too wide to fit through the birth canal, the labor is prolonged or the baby emerges from the birth canal feet first. In the event of one of these complications, the doctor often pulls too hard on the baby, resulting in an injury that could otherwise have been avoided with greater caution. When that happens, the doctor could be responsible for the injury to your child and you could be entitled to compensation to help defer the costs of medical care resulting from the injury. The statute of limitations for medical malpractice varies by state. Therefore, it’s important to contact a lawyer as soon as you suspect your child might be suffering from brachial plexus palsy.

Does my child have Brachial Plexus Palsy?

Brachial plexus injuries are often not immediately apparent after childbirth. If your child is presenting any of the following symptoms, he or she might be suffering from brachial plexus palsy:

• One or both arms are not moving properly. This could include difficulty with raising an arm above the head or swinging an arm from side to side.

• The affected arm may appear limp or paralyzed.

• The muscles in the affected arms reduce in size. If one of your baby’s arms starts to appear smaller than the other, this could be a sign of injury.

• Reduced or limited sensation in the affected arm. This could include sensitivity to temperatures or pain.

• The baby exhibits a weak grip in one hand.

• One of the baby’s arms rests in an odd position.

It’s important to note that symptoms could present themselves in the shoulder, arm, wrist or hand.

What should I do if I suspect my child has brachial plexus palsy?

It’s important to determine whether the injury is the result of negligence by the doctors that gave birth to your child. Therefore, besides visiting a doctor for a diagnosis, you should also consult with a lawyer. Treatment for the injury can be expensive and time consuming, and in the worst of cases, some never fully recover the full function of their shoulder, arm, wrist or hand.

How is brachial plexus palsy diagnosed?

• There is no single test to confirm a brachial plexus injury. The doctor will examine the affected arm for paralysis, numbness, position and grip strength. The baby’s reflexes, or startle response, will also be checked. This is done by laying the baby face up on a soft, padded surface. The doctor will then gently lift the baby’s head and body to release the baby’s weight from the surface, then suddenly release the baby without letting it hit its head. How the arms of the baby move in reaction to the perceived fall help doctors determine if there has been an injury. To make a diagnosis, the doctor might also conduct some of the following tests:

  
  

• X-rays

1. Magnetic resonance imaging (MRI)

2. Nerve conduction study (NCS)

3. Electromyogram (EMG) to test nerve and muscle function

4. Computed tomography (CT or CAT scan)

Forms of Brachial Plexus Palsy

Brachial plexus injuries can be divided into four categories based on the kind of nerve injury and the pattern of nerves involved.

Stretch

This is the most common form of brachial plexus injury. It occurs when the nerve has been stretched, but not torn. A baby may recover on its own within a few months after birth.

Rupture

This is when the nerve has been torn, but not at the point where it attaches to the spine. Treatment for a rupture may include surgery.

Avulsion

An avulsion occurs with the nerve roots are torn from the spinal cord. This happens in about 10 to 20 percent of cases. In this case, the damaged tissue needs to be replaced through a nerve transfer.

Neuroma

This occurs when the injury has gone undetected and the nerve has tried to heal on its own. Scar tissue forms and obstructs the function of the nerves. Treatment includes nerve reconstruction and/or secondary tendon transfers.

Other forms of brachial plexus palsy include:

Erb’s Palsy

This involves the upper portion of the brachial plexus. A child typically has weakness in the shoulder and bicep muscles. Home physical therapy is needed to prevent stiffness, atrophy, and shoulder dislocation.

Total Plexus Involvement

This is when all five nerves of the brachial plexus are injured. A child may not have any movement of the shoulder, arm, or hand.

Horner’s Syndrome

This is usually associated with a muscle tear. A child may exhibit a drooping eyelid, a smaller pupil of the eye and reduced sweat production in part of the face. Horner’s Syndrome is one of the more serious brachial plexus injuries.

Klumpke’s Palsy

This form is rarely suffered by babies or children. It usually affects the hand muscles.

Treatment

Depending on the severity of the injury, your child might require expensive surgery and long-term treatment. The sooner treatment begins, the better the results. The mildest of cases can often heal on their own. Moderate cases may require daily physical therapy. For a more serious injury, a child will require attention from several different specialists and his or her treatment could include:

• Nerve Grafts:  A nerve from another area of the body is used to patch the injured brachial nerve.

• Nerve Transfer:  A healthy nerve in the area, or some of its fibers, restores injured nerve connections.

• Muscle Transfer:  A muscle, usually taken from the child's thigh, replaces a paralyzed muscle in the arm.

• Tendon Transfer: Tendons are moved from working muscles near the shoulder to increase arm movement and control.

If you believe your child might be suffering from brachial plexus palsy, visit a doctor and consult with a lawyer as soon as possible. Delaying could complicate treatment and allow the statute of limitations to run out, which would deprive you of the financial compensation needed to pay for your child’s medical care.

Medical Malpractice Statute of Limitations for Minor Children for Birth Injuries

The statute of limitations for birth injuries varies by state. The following are the statute of limitations for the states in which the Law Offices of Daniel Weltin are licensed to practice law.

California: A lawsuit must be filed before the child’s eighth birthday.

Texas: A lawsuit must be filed before the child’s tenth birthday.

Hawaii: A lawsuit must be filed before the child’s tenth birthday.