Many nerve injuries before, during, or after childbirth take the form of brachial plexus injuries. The brachial plexus is a group of five nerves that transmit signals affecting sensory and motor functions from the spinal cord to the shoulder, arm, hand, and fingers. Brachial plexus injuries thus can affect sensations and muscle movements in any of these areas. Risk factors for brachial plexus injuries include a large fetus, breech birth, and prolonged labor. A child also may be more likely to sustain harm to their brachial plexus if they suffer from shoulder dystocia, which means that their shoulder gets trapped behind the pubic bone of the mother and cannot pass comfortably through the birth canal.
Brachial plexus injuries result from force that pulls the neck and shoulder away from each other, putting pressure on the nerves. This can cause the brachial plexus to stretch or tear, and nerve roots in the neck may even be separated from the spinal cord. Some of these injuries occur naturally and cannot be prevented, but others occur because a doctor or another health care provider made mistakes during childbirth.
Medical Errors Causing Brachial Plexus Injuries
Examples of medical errors that may damage the brachial plexus include improperly using forceps or other instruments in assisting delivery. In other cases, a baby could have avoided a brachial plexus injury if a doctor had recognized the risk of labor complications and performed a C-section instead.
Symptoms and Diagnosis of Brachial Plexus Injuries
Children with mild to moderate brachial plexus injuries may not suffer lasting harm. However, severe damage to the brachial plexus may result in a weak grip, a loss of sensation, or partial or complete loss of movement in the arm. The arm may hang limply or bend toward the body at an unnatural angle.
Tests used to identify a brachial plexus injury include CT or CAT scans, MRIs, and X-rays. A doctor also may use electromyography, which measures the electrical activity in skeletal muscles. In addition, they may perform a nerve conduction study to assess the function of the motor and sensory nerves in the area, including their electrical conduction capacity. Sometimes irregularities in the "startle response" of a child may guide a doctor toward this diagnosis. Also known as the Moro reflex, the startle response involves flinging arms and legs outward and then curling them inward toward the body when a baby is startled.
Treatment for Brachial Plexus Injuries
Sometimes damage to the brachial plexus resolves on its own over time without treatment. If it does not resolve, a child may undergo physical therapy, which often can be performed at home with the assistance of their parents. Serious brachial plexus injuries may require a more rigorous treatment plan, potentially involving a combination of physical therapy, occupational therapy, medications, rehabilitation techniques, and even surgery.
One type of surgical procedure that may help a child with a persistent brachial plexus injury involves transferring a healthy nerve, muscle, or tendon to the site of the damage. This can help repair or replace damaged areas and improve sensory and motor functions. A surgeon also might conduct a nerve graft. This often involves using a nerve from another part of the child’s body to patch over the damage to a nerve in the brachial plexus.
Surgical Benefits May Take Time
The results of surgery may not be apparent immediately. A child and their family can expect gradual improvements over the course of the next year, or even longer.
Compensation for Brachial Plexus Injuries
Unfortunately, medical malpractice during childbirth often plays a role in brachial plexus injuries. Damage may directly result from errors by a doctor, such as pulling the neck away from the shoulder while assisting delivery or failing to perform a C-section when this would have been appropriate. In other situations, avoidable complications may arise when a doctor fails to promptly diagnose and treat a brachial plexus injury that has occurred. This can make the difference between a complete recovery and long-term or even permanent disabilities.
A family may shoulder a heavy financial burden from the costs of treating a brachial plexus injury. They can recover compensation for therapies, surgeries, and other forms of treatment by establishing the liability of a health care provider for medical malpractice. This means that the health care provider did not meet the professional standard of care under the circumstances. Expert witnesses likely will need to testify about what the doctor should have done and how their deviation from proper practices caused harm to the child.
Affidavits of Merit
Often, a family bringing a birth injury lawsuit will need to submit an affidavit of merit from a medical expert at the outset of the case. This verifies that they have a valid basis for their claim.