Brachial plexus injuries occur when the network of nerves controlling the arm and hand is damaged during birth. These injuries often result from preventable delivery room errors during difficult vaginal deliveries.

Understanding the Brachial Plexus

The brachial plexus is a network of nerves running from the neck through the shoulder to the arm and hand. These nerves control movement and sensation in the entire upper extremity.

Types of Brachial Plexus Birth Injuries

Erb's Palsy (Upper Brachial Plexus)

Most common type, affecting nerves C5-C6:

  • Weakness in shoulder and upper arm
  • "Waiter's tip" position—arm rotated inward, elbow extended
  • Difficulty lifting arm and bending elbow
  • Often better prognosis for recovery

Klumpke's Palsy (Lower Brachial Plexus)

Less common, affecting nerves C8-T1:

  • Weakness in forearm and hand
  • Difficulty grasping objects
  • May affect fine motor skills

Total Plexus Involvement

Most severe, affecting all nerve roots:

  • Complete paralysis of arm
  • No movement or sensation
  • Often permanent

How Birth Injuries Cause Brachial Plexus Damage

Shoulder Dystocia

Shoulder dystocia occurs when the baby's shoulder becomes stuck behind the mother's pubic bone during delivery. This is the leading cause of brachial plexus injuries.

Improper management of shoulder dystocia can cause nerve damage:

  • Excessive lateral traction on head and neck
  • Pulling too hard to extract baby
  • Using improper maneuvers
  • Delaying appropriate interventions

Nerve Injury Mechanisms

  • Stretching (neuropraxia)—mildest, usually recovers
  • Tearing (neuroma)—partial recovery possible
  • Rupture—nerve torn, may require surgery
  • Avulsion—nerve root torn from spinal cord, worst prognosis

Medical Negligence in Brachial Plexus Cases

Failure to Anticipate Shoulder Dystocia

Risk factors that should have been recognized:

  • Large baby (macrosomia)—especially over 4,000-4,500 grams
  • Maternal gestational diabetes
  • Previous shoulder dystocia delivery
  • Maternal obesity
  • Post-term pregnancy
  • Prolonged labor

When risk factors are present, C-section may be indicated.

Improper Response to Shoulder Dystocia

Once shoulder dystocia occurs, proper maneuvers must be used:

  • McRoberts maneuver—flexing mother's legs
  • Suprapubic pressure—pushing above pubic bone
  • Woods' screw maneuver—rotating baby's shoulders
  • Delivery of posterior arm

Negligent providers may:

  • Use excessive force instead of proper maneuvers
  • Pull on head and neck inappropriately
  • Fail to call for help
  • Delay too long before intervention

Prognosis and Treatment

Recovery Rates

  • Mild cases (neuropraxia)—80-90% recover fully by 3-6 months
  • Moderate cases—may improve with therapy over 1-2 years
  • Severe cases (avulsion)—permanent damage likely

Treatment Options

  • Physical therapy—maintain range of motion, build strength
  • Occupational therapy—improve function and adaptation
  • Botox injections—reduce muscle tightness
  • Surgery—nerve grafting, muscle transfers (for severe cases)

Damages in Brachial Plexus Cases

Medical Expenses

  • Years of therapy—often multiple sessions weekly
  • Surgeries if needed—$50,000-$150,000+
  • Ongoing orthopedic care
  • Equipment and adaptive devices

Impact of Permanent Injury

If arm function doesn't fully recover:

  • Career limitations—many jobs require two functional arms
  • Difficulty with daily activities
  • Cosmetic differences—arm may be smaller, positioned differently
  • Ongoing pain in some cases

Typical Case Values

  • Temporary injuries with full recovery—lower values
  • Permanent weakness or limitation—$500,000-$2 million+
  • Severe permanent paralysis—$2-5+ million

Proving Your Case

Key Evidence

  • Medical records—documenting delivery complications
  • Delivery notes—what maneuvers were used
  • Birth weight—establishing macrosomia risk
  • Prenatal records—showing risk factors were present

Expert Testimony

Cases require obstetric experts to establish:

  • Standard of care was violated
  • Excessive force was used
  • Proper maneuvers weren't employed
  • C-section should have been offered

Conclusion

Brachial plexus injuries are often preventable with proper delivery management. When medical negligence causes nerve damage affecting your child's arm, you deserve compensation for medical expenses, therapy, and the impact on your child's life. Consult an experienced birth injury attorney to evaluate your case.