A Study of Two Erb's Palsy Medical Malpractice Cases

Childbirth brings with it the possibility of complications and injuries to the baby. One such injury, Erb's palsy, can affect a baby's shoulder, arm and hand. This can leave the baby with a limp arm. There are factors that, if present during the pregnancy, can indicate that the baby is at an increased risk for an Erb's palsy injury. When these factors are present, the doctor delivering the baby should take appropriate steps to avoid the injury. Failure to do so may constitute medical malpractice.

Erb's palsy injuries most often occur in situations involving (1) a large baby, (2) a breech position or (3) prolonged labor. These factors generally make a natural delivery difficult. In order to complete the vaginal deliver, the doctor or other health care professional may perform maneuvers (sometimes involving the use of forceps or a vacuum) that can cause excessive pulling on the shoulders during a headfirst delivery or put excessive pressure on the arms during a breech delivery. As a result, nerves in the network of nerve fibers that send signals from the spinal cord to the shoulder, arm, wrist, hand and fingers are damaged. This leads to a lack of control over movement and sensation in those areas.

There are four types of injuries that can occur to these nerves. In increasing order of severity, these are:

1. Praxis. The nerve is damaged but not torn.

2. Neuroma. The injured nerve develops scar tissue. This reduces or blocks the signals sent by the brain to the muscles.

3. Rupture. The nerve is ripped but remains attached to the spine.

4. Avulsion. The nerve is torn from the spine.

Many babies suffer from the milder forms of Erb's palsy and are able to fully recover within 6 months. Physical therapy may constitute an integral part of treatment. In cases involving a rupture or tear of the nerves, however, surgery may be necessary. Sometimes, multiple surgeries are required.

To be effective, surgery must normally be performed before the baby is one year old. Even when successful, it may take years for the child to regain sensation and movement of the arm, shoulder or arm. This is due to the slow growth of nerve tissue. Postsurgical rehabilitation usually involves extensive physical therapy exercises and other coordinated treatments. When surgery is not fully successful, the child may be left permanently unable to have full, or sometimes even partial, use of the affected arm.