Brachial Plexus Palsy - Medical Negligence Solicitors
Complete brachial plexus palsy may be caused by a birth injury as a result of medical negligence if excessive traction is used during delivery thereby stretching and damaging the nerve network. If you believe that your child’s injury has been caused by clinical errors we are able to offer advice at no cost and without further obligation from a brachial plexus palsy solicitor. Just call the solicitors helpline or complete the contact form or email our lawyers offices and a bracial plexus palsy medical negligence solicitor will phone with information about how to protect your childs legal right to compensation. Our bracial plexus palsy medical negligence solicitors deal with suitable claims using the no win no fee scheme.
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Brachial Plexus Palsy
The braxchial plexus is a network of nerves that emanate from the spinal cord in the region of the neck and pass across the shoulder and chest before terminating at the fingers. Damage to these nerves can cause serious injury that affects control of the arm and hand including full paralysis. Brachial plexus injuries which may be the result of medical negligence include Klumpkes palsy, Erbs palsy, torticollis and complete brachial plexus palsy. If you need legal advice at no cost, just call our brachial plexus palsy solicitors on the helpline.
The most severe of all of the potential injuries is complete brachial plexus palsy where all five nerves that comprise the brachial plexus are damaged. Victims often suffer from complete paralysis of the arm with Horners syndrome and torticollis.
Erbs palsy is specific form of brachial plexus injury caused by a injury to certain defined brachial plexus nerves which causes typical symptoms of restricted motion of the hand and arm, to varying degrees, often accompanied by an upturned hand, pointing backwards in a 'waiters tip' position. A brachial plexus injury can result in severe disability and in some cases is caused by medical negligence as a result of a traumatic birth or may be caused to an adult by a traumatic accident. There are risk factors which demand vigilance by healthcare practitioners.
Less than 1% of newborn children suffer from brachial plexus injuries most of which are due to medical negligence and are avoidable if healthcare practitioners carry out their work properly. Initial risk factors which should make a doctor or midwife vigilant and make plans for a caesarean section include :-
- unusually large infant
- mother with diabetes
- unresolved shoulder dystocia
- failure to deliver with normal application of force
Most cases of medical negligence fall into two categories both of which indicate a lack of reasonable care on the part of the healthcare practitioner especially in the presence of the recognised risk factors :-
- failure to follow the established medical protocols to alleviate shoulder dystocia which occurs when the infants shoulder becomes trapped behind the mothers pubic bone during delivery
- failure to plan a caesarean section when the warning signs were evident alternatively failure to carry out a caesarean section as a result of shoulder distocia becoming evident during delivery
Brachial Plexus Palsy Overview
Erbs palsy is a form of brachial plexus palsy. The brachial plexus is a network of nerves located near the neck. It forms the nerves that attend to the arms. They provide sensation and motor function to the arm, hand and fingers. When there is a palsy, it means there is a weakness. Brachial plexus birth palsy causes a congenital loss of function of the affected arm.
One to two out of every 1,000 live births has brachial plexus palsy. It is caused by the doctor putting too much lateral stretch on the neck during a difficult delivery.
Most infants who suffer from brachial plexus palsy at birth will recover both feeling and movement in the affected limb. Parents must actively participate in the treatment process to make sure that a maximum amount of recovery can happen.
The brachial plexus is formed as the nerves to the upper extremity go from the spinal cord between the bones of the vertebrae and out to the arm. The nerves 'mix and match' in the neck and axilla so that individual nerves are formed that go out to the arm. The system of nerves goes underneath the collar bone before spreading out innervate the upper extremity.
In most situations of brachial plexus palsy, it is the upper nerves that are affected first. When just the upper nerves are affected, it is called Erbs palsy. The infant may lose the ability to move the shoulder but can move the fingers; if both the upper and lower nerves are affected, the condition is worse than Erbs palsy and is referred to as global or total brachial plexus palsy.
Usually, there are four types in injuries to the nerves. They can all happen at the same time in any given infant. These include the following:
- Neuropraxia. This involves a shock injury to the nerve with no tearing of the nerve. They usually heal spontaneously.
- Avulsion. The nerve is torn from the spinal cord. It Is an irreparable injury that can be fixed only if a donor nerve is used from another muscle.
- Rupture. This is a stretch injury that causes the nerve to be torn apart or ruptured. It will not health without surgical intervention.
- Neuroma. This is damage to nerves that result in scar tissue that pushes on surrounding nerves. The scar tissue is called a neuroma. There is usually some but not total recovery.
The cause of brachial plexus injuries usually involves an attempt to deliver the infant shoulders and body once the head is out. The doctor puts too much lateral traction on the fetal head and does the above damage to the brachial plexus. It can happen with a breech presentation that has the body out but the doctor is putting traction on the neck to get the fetal head out.
Symptoms of brachial plexus palsy in an infant include a lack of feeling in the arm, weakness in the affected arm and partial to total paralysis in the arm.
The diagnosis of brachial plexus palsy is usually a clinical diagnosis. The pediatrician can notice the lack of movement and sensation on the affected arm and can make a diagnosis of Erbs palsy or brachial plexus palsy. X-rays can be done to make sure there is no bony injury, such as a clavicular fracture. An electromyogram or EMG can check to see if the muscles are innervated. A nerve conduction study can be done to see if the patient has nerve function in the affected arm.
It can take up to two years for spontaneous recovery from a brachial plexus palsy. Daily physical therapy is the main treatment. It involves passive moving of the joints to prevent contractures. The physical therapist will teach the parents how to do these exercises, starting at 3 weeks of age.
If there is not improvement after the first 3-6 months of therapy, the doctor may do surgery to see if there is anything that can be fixed. Surgery on the nerves won't completely restore function but it can gradually improve function.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here