A precursor condition associated with many brachial plexus birth injuries is shoulder dystocia, a condition that occurs during the birthing process when an infant's shoulder becomes lodged behind the mother's pubic bone. Shoulder dystocia is a high-risk birthing complication that risks serious and permanent damage to the baby's nerve tissues between the arm and the shoulder, the brachial plexus nerves. Brachial plexus injuries, sometimes called obstetrical brachial plexus, can range from a mild muscle stretch injury to a complete separation (avulsion) of nerves from the spinal cord.
Shoulder Dystocia Risk Factors
An obstetrician should be able to identify the common risk factors for shoulder dystocia, and should take precautions to avoid brachial plexus birth injuries. Risk factors for shoulder dystocia include pregnancy beyond 40 weeks, prolonged labor, short maternal stature, heavy maternal stature, maternal diabetes, high birthweight infants, breech birth, and use of forceps or vacuum during birth. If an obstetrician is aware of high risk factors for shoulder dystocia, scheduling a caesarian section can usually prevent a birth injury.
Types of Brachial Plexus Injuries
Brachial plexus injuries can be classified as one of four types: (1) Avulsion injuries; (2) Rupture injuries; (3) Neuroma Injuries; and (4) Neuropraxia injuries. Avulsion injury, where the nerve is torn from the spine, is the most serious type of brachial plexus injury. Rupture injuries cause nerve tearing, but not separation from the spinal cord. A neuroma is the existence of scar tissue surrounding a torn nerve, which puts pressure on the injured nerve. Neuropraxia injuries, also known as praxis injuries, are brachial plexus injuries where the nerve is not torn, and the injury heals on its own over the course of several months.
Brachial Plexus Injury Diagnosis & Treatment
Surgical intervention may be necessary for babies born with severe brachial plexus birth injuries. Other non-surgical treatments may also be recommended, including botulinum toxin injections, electrical stimulation and physical therapy. Babies that recover from brachial plexus injury usually show improvement by four months of age. Infants that are slower to recover are less likely to completely recover. Complete paralysis of the shoulder, arm and hand is known as Complete Brachial Plexus Palsy. Two other neonatal brachial plexus palsies are Erb's Palsy and Klumpke's Palsy.
Erb's palsy is a weakness of the upper arm due to a brachial plexus birth injury. Neuropraxia injuries, the mildest form of brachial plexus injury, cause Erb's Palsy in the location where the injury occurred. A baby diagnosed with Erb's palsy may be unable to move their arm, but may be able to move their fingers. Some babies born with Erb's Palsy fully recover, and others do not.
Dejerine-Klumpke palsy (Klumpke's palsy) is a weakness or paralysis caused by an injury to the lower part of the brachial plexus. Damage to the seventh and eighth cervical and first thoracic nerve cause Klumpke's Palsy. Symptoms include fingers that do not move and a limp wrist and hand. Some babies with Klumpke's Palsy also are diagnosed with Horner's syndrome, a condition where one pupil is smaller than the other, and eyelids are droopy.
Brachial Plexus Birth Injury Lawsuits
Some cases of brachial plexus injuries may be caused by the negligent actions of an obstetrician, physician, nurse, or caregiver. Although not all cases of brachial plexus injury can be attributed to hospital or doctor negligence, this type of injury is a common injury associated with medical malpractice and medical negligence. If your child suffers from Erb's Palsy or Klumpke's Palsy due to a brachial plexus injury at birth, you should contact an experienced birth injury attorney for a review of your legal rights. You may be entitled to compensation for your medical expenses, time away from work, and pain and suffering.
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