Brachial Plexus Injuries at Birth

The brachial plexus is a bundle of nerves that originate in your neck and extend through your shoulders and down to your fingers. There are five major nerve branches within the brachial plexus – each controlling different muscle functions. We use the muscles controlled by the brachial plexus nerves every day without realizing it – this includes flexing the upper arms and elbows, rotating the shoulders, and movements of the upper arm, forearm, elbow, and fingers. Given the frequency with which we use these movements, an injury to the brachial plexus can be devastating, and can significantly limit an individual’s ability to perform basic everyday tasks.

The severity of brachial plexus injuries can vary widely. Some brachial plexus injuries only impact the upper branch of the brachial plexus nerves, sparing any loss of function in the forearm or fingers. Other brachial plexus injuries can impact all five nerves of the brachial plexus. These injuries, often referred to as “total” or “global” injuries, can result in the loss of function at the shoulder, arm and hand.

How much function is lost at any one nerve depends on the nature of each injury. Sometimes, brachial plexus nerves are stretched but not torn. These stretch injuries (also called neurapraxia injuries) are the most common type of brachial plexus injuries. Fortunately, these stretch injuries may resolve with time. But not all of them do, and stretch injuries may still cause permanent damage to one of the brachial plexus nerves. In that situation, a child may have limited or no use of a shoulder, arm or hand. 

If a brachial plexus nerve is stretched beyond its limits, it will tear. If the nerve is torn where it attaches to the spinal cord, it is called an avulsion. A nerve avulsion is the most severe form of brachial plexus injury. It cannot be surgically repaired unless the surgeon harvests a nerve from another part of the patient’s body and transfers it to the affected nerve root. Avulsions can also cause complications beyond the upper extremity, such as a droopy eyelid or difficulty breathing. If the nerve is torn outside of the spinal column, it is referred to as a rupture. A nerve rupture is still a very significant brachial plexus injury and may require surgery.

Brachial plexus injuries can be caused by any trauma to the neck. As it relates to medical malpractice claims, brachial plexus injuries are most commonly caused during birth. For a brachial plexus injury to occur, there must be some widening of the neck and shoulder to place strain on the brachial plexus, and some force to cause an injury. 

Brachial plexus injuries commonly occur in deliveries complicated by a condition called shoulder dystocia. Briefly, shoulder dystocia refers to a situation where, during labor and delivery, the baby’s shoulder becomes stuck on the mother’s pubic bone as the baby travels down the birth canal. When this complication occurs, the physician or nurse midwife must quickly act to relieve the stuck shoulder so that the baby can be delivered safely. 

While there are recognized maneuvers used by the physician or midwife to dislodge the stuck shoulder, it is crucial that they are performed both quickly and gently. Medical providers are trained not to apply too much force when delivering a baby or to pull the baby’s head too far from the shoulders. If too much force is applied, or if the delivering medical provider pulls the baby’s head too far from the shoulders, this can injure the brachial plexus nerves and can lead to a severe and permanent brachial plexus injury. Brachial plexus injuries at birth can also occur without shoulder dystocia, and under the same conditions – where a medical provider uses too much force to deliver the baby and injures the brachial plexus nerves, typically by pulling too hard on the baby during delivery. When medical providers fail to do what they were trained to do in this situation, they may have committed medical malpractice and should be held accountable for the injuries that they caused.

Determining whether your child’s brachial plexus injury was caused by medical malpractice requires a close review of the evidence, including the medical records and eyewitness accounts. Oftentimes, when a brachial plexus injury occurs at birth, the medical providers involved in the delivery do not detail every aspect of the delivery attempt, including the amount of force used. For this reason, it is important to have an accurate account from those who were in the room at the time of delivery. Those witnesses may remember whether the physician struggled while pulling the baby, how many pulls were used, and the direction of the baby’s head when the pulling occurred. All of this information can be helpful to evaluate a case. 

In addition to what happened in the delivery room, there may have been warning signs prior to delivery which the physician should have recognized to plan for the potential complication of shoulder dystocia, which increases the risk of a brachial plexus injury. These warning signs include the mother’s history of a prior shoulder dystocia, a large baby (fetal macrosomia), a baby being in a poor position for delivery (fetal malposition), and labor abnormalities. If a mother or her baby present with these (or other) warning signs, the child may be far more likely to suffer from a brachial plexus injury. In that situation, the physician or healthcare provider caring for the mother during her pregnancy must counsel her on the risks of a vaginal delivery, and may be required to advise the patient that a Cesarean section is a safer delivery option for the baby. If healthcare providers fail to inform the mother of these risks and different birthing options, they may have committed medical malpractice, and allowed an otherwise preventable brachial plexus injury to occur.

If your child suffered a brachial plexus injury at birth, you should certainly discuss the next steps with your child’s medical providers to ensure that your child is sent to a specialist who knows how to evaluate and treat these injuries. As mentioned above, some brachial plexus injuries are only temporary and will resolve with time. If the injury is more severe, your child may need surgery and therapy. 

A brachial plexus injury can cause life-long difficulties with everyday activities, requiring modifications to school activities, job responsibilities, and leisurely activities. It may also require ongoing therapy to prevent the impact of the child’s injury from worsening over time. Future activity modifications and therapy over the course of a lifetime can be very expensive. These injuries can also cause physical disfigurement and significant emotional harm to a child or parent, as these injuries may make the child feel different and impact his or her social well-being. 

If your child’s brachial plexus injury was caused by medical malpractice, the physician is responsible for the cost of your child’s future needs and the harms it has caused, including any pain and suffering. It is very important to retain a lawyer who is experienced in assessing which experts can appropriately predict your child’s future needs, and their associated costs. The medical malpractice attorneys at Morris James have such experience, and can assist you and your child in presenting a claim to ensure future needs are covered by any settlement or verdict.

If your child has been diagnosed with a brachial plexus injury, and if you believe that you or your baby were not treated appropriately during your pregnancy or labor and delivery, then you should consider speaking with an attorney. Given the complexity of pregnancy and the labor and delivery process, it can be difficult to determine whether a healthcare provider’s medical malpractice caused the child’s brachial plexus injury. Hiring a medical malpractice lawyer who has handled several cases involving significant brachial plexus injuries is key to making these determinations, because the lawyer has the tools and knowhow to investigate your case to determine whether the medical team committed medical malpractice, and to prove such a claim in the court of law. An experienced birth injury lawyer also knows how to get answers from your healthcare team, and can make them pay fair compensation for your and your child’s injuries.

The medical malpractice attorneys at Morris James have handled many complex birth injury cases, including those involving brachial plexus injuries. They are familiar with the issues in these cases, including the types of future care required for the child’s needs, the variety of experts who can support a claim for malpractice, and the hurdles healthcare providers place before families who simply want answers about this devastating condition. Our attorneys know how to fight for your rights and will, if necessary, go to trial to obtain the maximum compensation for your child’s brachial plexus injury.