Brachial Plexus Palsy

The brachial plexus is a group of nerves that run from the shoulder to the spine. These control muscle movement in the hands, arms and shoulder. Sometimes when a doctor is negligent by not providing proper obstetrical care, damage to the nerves can result. These injuries usually occur during the natural delivery of a larger infant. When the baby is too large to pass through the mother's pelvis, his or her shoulder may become lodged behind the mother's pubic bone after the head has been delivered. Many times the doctors attempt to continue with a natural delivery, as opposed to a C-section and can stretch the neck excessively causing nerve damage.

There are three types of Brachial Plexus injuries:

1. Stretch - which vary in degrees of intensity, however nerves in plexus are often compressed due to swelling or bruising from birth trauma of shoulder getting caught on the pelvic bone. Stretch injuries will spontaneously recover in 1-2 years of age with 90-100% return of function. neuroma which is scar tissue that compresses the nerves may occur also and surgical intervention is needed to remove it.

2. Rupture - nerves are torn at either one or several places in the plexus requiring surgery for the nerves to recover.

3. Avulsion (most severe injury) - nerves are pulled from the spinal cord as evidenced by a totally flaccid extremity, which requires surgery and possibly muscle transfer to gain function. Horner's syndrome may be present if this is involved.

Erb's Palsy and Klumpke's Palsy

This is an injury to the nerves in infants. Erb's refers to damage to the upper plexus ( C5 to C7) , Klumpke's Palsy is damage to the lower plexus (C8 to T1). Both conditions result in weakness or paralysis generally caused by stretching of the nerves delivery.

Doctors can be negligent when they don't properly identify a large baby and perform a C-section, or use inappropriate delivery techniques once they encounter shoulder dystocia.

Children with Erb's Palsy have lack of movement in the arm and shoulder, while children with Klumpke's Palsy have diminished movement in the wrist and hand. Doctors should be able to identify the potential for a large baby by the following factors:

a. Gestational diabetes - which generally is associated with larger babies. A doctor should always prenatally timely screen and treat for this condition.

b. Excessive weight gain during pregnancy. The chance of a large baby is greatly increased if there is excessive weight gain, especially for mothers over 30 years old.

c. Obesity. An obese mother has a greater risk of giving birth to a large infant.

d. Maternal history. If a mother has previously delivered a large infant, there is a greater chance that the next infant will also be very large.

e. The fundal height or McDonald measurement. These measurements recorded during pre-natal visits to her doctor is an external measurement from the top of the pubis to the top of the uterus. If these measurements are too large the physician should be able to determine if there is a large baby.

Doctors should recognize the above indicators of a probable large baby and confirm his suspicion through the use of ultrasound. Accordingly, the doctor may be liable if he doesn't use the correct delivery technique, including the McRoberts maneuver, Wood's corkscrew maneuver, as well as suprapubic pressure. A cesarean section should also be done where appropriate.

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