Texas Brachial Plexus Injury

Brachial Plexus Palsy

With brachial plexus palsy, the five nerves on both side of the neck and shoulder area that run from the spinal cord to the arms (the brachial plexus) are damaged. The damage impairs the use of the arms, wrists or hands. In most cases, only one arm is affected, and symptoms may include reduced sensation in the arm, lack of arm muscle control or paralysis. The principal cause of brachial plexus palsy is childbirth involving shoulder dystocia. Dystocia means a difficult labor or delivery, and in this case, labor is difficult because the shoulder will not easily pass through the mother’s pelvis.

What is Shoulder Dystocia?

After the baby's head is delivered, the baby's shoulders are perpendicular to the floor. If the baby's shoulders are too wide or the mother's pelvis is too narrow, shoulder dystocia can result. The brachial plexus injury results from the doctor pulling down on the head to disimpact or free the stuck shoulder. While doctors may use gentle traction on the baby's head during a normal delivery, traction or pulling on the head must be avoided when a shoulder dystocia is encountered. However, delivering doctors often rush the delivery and try to pull the baby out of the birth canal by tugging on the baby's head, an action, which can result in brachial plexus palsy. Doctors and nurses should be trained in handling obstetrical complications in a calm and cool manner.

There are multiple accepted maneuvers used to free the baby's shoulder when it is stuck. Such maneuvers include pushing the mother's legs to her chest and having the nurse apply pressure on an angle by the mother's pubic bone. The nurses or delivery room personnel should never apply pressure on a woman's upper abdomen because the pressure can get the baby's shoulder stuck further and stretch the brachial plexus nerves. This inappropriate maneuver is called fundal pressure.

Prenatal Factors that Risk Shoulder Dystocia

Based on concerns of birth trauma, certain women should not have a vaginal delivery. Prenatal factors that a doctor should consider include:

• Diabetes during pregnancy
• An expected large baby
• A small pelvis
• Excessive maternal weight gain
• Obstetric history
• Maternal obesity
• Gestational age

Risk of a traumatic delivery can also arise if there is a long labor, the need for forceps or a vacuum extractor, or if a baby’s descent down the birth canal is prolonged. When such factors are present, an obstetrician should consider performing a Cesarean section.

Medical Treatment for Brachial Plexus Injury

If your baby has an arm that was limp after delivery and has not recovered on its own, there is medical treatment and attention, which can improve the long-term outcome of brachial plexus injuries. It is essential that physical and occupational therapy begin and a referral to a pediatric neurologist be carried out. Neurosurgeons and plastic surgeons work together in performing surgery to clean and re-attach nerve fibers to the injured and effected brachial plexus nerves. The surgery must be conducted at a very young age while there is potential for nerve regeneration. Subsequent surgeries may include muscle and tendon transfers at various age intervals. Ultimately, the child may regain some function in the shoulder, arm, elbow, wrist or fingers as the result of these procedures. At Texas Children's Hospital, the Brachial Plexus Clinic is dedicated to helping children with brachial plexus injuries.

Permanent Damage

Permanent brachial plexus injuries are very significant to the impaired child. They may affect the child's ability to perform basic life functions. The arm may appear shorter and withered; there may be pain and discomfort associated with using and stretching it. Ultimately, when the child becomes an adult, he or she may have trouble getting a job. The use of only one arm limits job opportunities because sixty percent of American jobs require the use of two arms.

As many parents of children with a brachial plexus injury know, these severe and permanent injuries significantly impact a child's future.

Legal Help for Brachial Plexus Palsy

Parents often struggle to handle the financial burden that brachial plexus palsy imposes. If the condition resulted from medical malpractice, legal remedies are available. At the Talaska Law Firm, our lawyers have extensive experience with brachial plexus cases and can help you determine whether pursuing a medical malpractice lawsuit to recover compensation is a viable option. There is no charge for a consultation to evaluate your case.

Because we take cases on a contingency fee basis, there are no out of pocket expenses, and fees are only owed after we recover on your behalf. Time limitations exist for filing claims against medical malpractice, so it is wise to contact a medical malpractice lawyer as soon as possible.

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