Erbs Palsy / Brachial Plexus Palsy
Erb's Palsy, also known
as
Brachial Plexus Paralysis,
is a condition which mainly due
to birth trauma can affect 1 or
all of the 5 primary nerves that
supply the movement and feeling
to an arm. The paralysis can be
partial or complete; the damage
to each nerve can range from
bruising to tearing. Some babies
recover on their own; however,
some may require specialist
intervention.
The brachial
plexus is a network of nerves. It conducts
signals from the spine to the arm and hand.
These signals cause the arm and hand muscles to
move. (Brachial means arm, and plexus
refers to a network of nerves.)
Children with
brachial plexus injuries 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.
Your child's disability depends on which nerves
are injured and how severely they have been
damaged.
Brachial plexus injuries in newborns
usually occur during a difficult delivery, such
as with a large baby, a breech presentation, or
a prolonged labor, when the person assisting the
delivery must exert some force to pull the baby
from the birth canal. One side of the baby's
neck is stretched, which can damage the nerves
by stretching or tearing them. If the upper
nerves are affected, the condition is called
Erb's palsy. The infant may not be able to move
the arm, but may be able to move the fingers.
Injuries that involve both the upper and lower
nerves are more severe and result in a condition
called global palsy.
There are four types of nerve injuries to the
brachial plexus.
- Avulsion injuries. The nerve is torn
from its attachment to the spinal cord. This
is the most serious type of injury.
- Rupture injuries. The nerve is torn, but
not at the spinal cord.
- Neuroma injuries. These injuries result
from scar tissue that forms and puts
pressure on the nerve.
- Stretch injuries. These injuries, known
as neurapraxia (new-rah-PRAK-see-ah) are the
most common. The nerve is damaged but not
torn. Normally, these injuries heal on their
own, usually within three months.
Some instances of Erb’s Palsy may have been
prevented had the warning signs been properly
evaluated. A failure to pick up on such warning
signs may be considered negligence if certain
actions by the physicians or medical staff could
have helped prevent the injury from happening.
Erb’s Palsy cases usually involve one or more of
the following issues:
-
Failure to estimate the baby's weight before
delivery
-
Failure to perform a C- section when
warranted
-
Failure to diagnose and treat gestational
diabetes
-
Failure to inform parents of the risks
associated with delivering a large baby
-
Use of excessive force during the delivery
This is not to say that all Erb's Palsy cases
are the result of negligence. Often there is
little or nothing a doctor could have done.
Parents should, however, consider the
possibility that a doctor may not have done all
that was possible to prevent Erb's Palsy.
Medical
malpractice claims are complex legal cases that
require an experienced attorney to settle or
litigate your birth injury lawsuit. A thorough
review of the medical records, interviews with
hospital staff, evidence analysis, and expert
medical witnesses are all important elements of
a medical malpractice suit. Only an experienced
birth injury attorney can effectively review
your situation and advise you of your rights.
Related Questions
& Answers What are
Brachial Plexus Injuries?
The brachial plexus is a network of nerves that
conducts signals from the spine to the shoulder,
arm, and hand. Brachial plexus injuries are
caused by damage to those nerves. Symptoms may
include a limp or paralyzed arm, lack of muscle
control in the arm, hand, or wrist, and lack of
feeling or sensation in the arm or hand.
Although injuries can occur at any time, many
brachial plexus injuries happen during birth:
the baby's shoulders may become impacted during
the birth process causing the brachial plexus
nerves to stretch or tear. There are four types
of brachial plexus injuries:
avulsion, the most severe type, in which
the nerve is torn from the spine;
rupture, in which the nerve is torn but not
at the spinal attachment;
neuroma, in which the nerve has tried to
heal itself but scar tissue has grown around the
injury, putting pressure on the injured nerve
and preventing the nerve from conducting signals
to the muscles; and
neuropraxia or
stretch, in which the nerve has been
damaged but not torn. Neuropraxia is the most
common type of brachial plexus injury.
Is there any treatment?
Some brachial plexus injuries may heal
without treatment. Many children improve or
recover by 3 to 4 months of age. Treatment
for brachial plexus injuries includes
occupational or physical therapy and, in
some cases, surgery.
What is the prognosis?
The site and type of brachial plexus injury
determine the prognosis. For avulsion and
rupture injuries there is no potential for
recovery unless surgical reconnection is
made in a timely manner. For neuroma and
neuropraxia injuries the potential for
recovery varies. Most patients with
neuropraxia injuries recover spontaneously
with a 90-100% return of function.
What are Erb-Duchenne and
Dejerine-Klumpke Palsies?
The brachial plexus is a network of nerves that
conducts signals from the spine to the shoulder,
arm, and hand. Brachial plexus injuries are
caused by damage to those nerves.
Erb-Duchenne (Erb's) palsy refers to
paralysis of the upper brachial plexus.
Dejerine-Klumpke (Klumpke's) palsy refers
to paralysis of the lower brachial plexus.
Although injuries can occur at any time, many
brachial plexus injuries happen when a baby's
shoulders become impacted during delivery and
the brachial plexus nerves stretch or tear.
There are four types of brachial plexus
injuries:
avulsion, the most severe type, in which
the nerve is torn from the spine;
rupture, in which the nerve is torn but not
at the spinal attachment;
neuroma, in which the nerve has torn and
healed but scar tissue puts pressure on the
injured nerve and prevents it from conducting
signals to the muscles; and
neuropraxia or
stretch, in which the nerve has been
damaged but not torn. Neuropraxia is the most
common type of brachial plexus injury. Symptoms
of brachial plexus injury may include a limp or
paralyzed arm; lack of muscle control in the
arm, hand, or wrist, and lack of feeling or
sensation in the arm or hand.
Is there any treatment?
Some brachial plexus injuries may heal
without treatment. Many children who are
injured during birth improve or recover by 3
to 4 months of age. Treatment for brachial
plexus injuries includes physical therapy
and, in some cases, surgery.
What is the prognosis?
The site and type of brachial plexus injury
determines the prognosis. For avulsion and
rupture injuries, there is no potential for
recovery unless surgical reconnection is
made in a timely manner. The potential for
recovery varies for neuroma and neuropraxia
injuries. Most individuals with neuropraxia
injuries recover spontaneously with a
90-100% return of function.
Information by: National Institute of
Neurological Disorders and Stroke
http://www.ninds.nih.gov/disorders/brachial_plexus_birth/brachial_plexus_birth.htm
Erbs Palsy Online Resources
Nerve Compression Syndromes Therapy
Brachial Plexus Injuries
Brachial Plexus Birth Injuries
Orthopaedic Articles | Brachial Plexus Palsy
Brachial Plexus Injury / Erb's Palsy |
