ERBS PALSY SOLICITORS COMPENSATION CLAIMS

Many cases of erbs palsy result in a solicitors claim for compensation for medical negligence against the hospital or healthcare practitioners involved in the birth. In almost every potential UK medical negligence case public funding commonly known as legal aid will be granted by the Legal Services Commission to a child with no financial contribution being necessary notwithstanding the parent's income or assets which are nor considered during the assessment process for a child applicant. It should be noted that the Legal Services Commission will insist that the solicitor acting on behalf of a legally aided child in a medical negligence claim is a an accredited specialist who is a member of the Law Society panel of clinical negligence experts. Medical negligence arises when a healthcare professional fails in their duty of care to the patient and reasonably foreseeable harm occurs as a direct result of that breach. Medical negligence is the failure of a health care practitioner to treat and care for a patient with a reasonable degree of skill and care. The standard of care is not absolute but is established by what is normal within the medical profession. Failed treatment is not necessarily negligent treatment merely because of its failure and will be exonerated if a substantial body of the medical profession would have carried out similar treatment notwithstanding that other more established treatment may have been more successful provided that such minority treatment was logical in all of the circumstances. Damages that can be awarded in these cases can be substantial and may include such elements as lifelong care, medical expenses and estimated future loss of potential income. Subject to a few statutory exceptions a solicitors medical negligence compensation claim must either have been settled by the payment of or agreement to pay compensation or proceedings must have been issued in a court of law by the eve of the 21st birthday failing which the opportunity to claim damages may have been lost forever.

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Erbs palsy is an injury most often caused to a child during the birth process, the symptoms of which may be visible immediately after birth. There is a group of known factors that predispose the foetus to this condition. The injury is caused by damage to the group of nerves that branch out from the spinal cord in the area of the neck and then form a network that passes across the shoulder called the brachial plexus and then along the arms to the tips of the fingers. These nerves control movement of the arms, hands and fingers and permanent disruption can cause serious long term disability. The symptoms can include a limp or paralysed hand with lack of muscle control and reduced sensitivity or numbness in the arm, hand or wrist. A baby suffering from Erb's palsy usually holds the affected arm down at the side rather than flexed up against the body. In addition the startle reflex has limited effect on the affected arm which does not move as would be expected.

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The word 'palsy' in plain English means, and is interchangeable with the word 'paralysis' which indicates a loss of movement of a part or parts of the body which is usually an indication of a restriction in full or in part in the ability to contract or release a muscle or a group of muscles. This restriction of movement is usually caused by damage or irritation to nerves or may be as a result of brain damage. Examples include Erb's palsy (damage to the brachial plexus network of nerves), cerebral palsy (irreversible brain damage) and Bells palsy (irritation of the nerves that control movement of the face). Damage to nerves can be caused as a result of direct physical force or may be indirect as a result of exposure to irritants or pollutants both before and after birth. Erbs palsy is frequently a birth injury caused by the use of excessive force often precipitated by a medical emergency such as shoulder dystocia during birth which is life threatening and demands an immediate solution. (In certain cases, where there may be an allegation of inadequate health care, it may be advisable to discuss this injury with a clinical negligence solicitor.) The group of muscles that are affected in this condition are the biceps, deltoid and other muscles that surround the shoulder joint and upper back. (There are other conditions that are often associated with Erbs palsy including Horners syndrome, Kulmpkes palsy and torticollis.)


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Erbs palsy is often caused by the use of excessive force during delivery particularly when the child’s shoulder has become lodged behind the mothers pelvis resulting in the over zealous use of force by the midwife or delivering doctor which results in a tearing of the muscle and nerves in the area of the shoulder and also not infrequently results in a fracture of the collar bone situated in the shoulder. Incidents of this type are described as shoulder dystocia and it is understandable how the subsequent injury to the child occurs in the heat of the moment in what is usually seen as a medical emergency. Most hospitals have a policy for dealing with shoulder dystocia and follow established protocols after calling the most senior staff available.

shoulder dystocia

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Erbs palsy is frequently caused by the use of excessive force or inappropriate traction on the infants head or neck during childbirth often resulting from a failure to deal with a position of risk that may have been encountered or become obvious in the earlier stages of birth or pregnancy. There are a number of risk factors that should dictate a caesarean section to preclude the risk of shoulder dystocia and included in this group are a large estimated birth weight, maternal diabetes, older mothers, short maternal stature, the mother’s narrow pelvis or a similar problem in a previous birth. In addition there are cases where there are other indicators during birth including a prolonged second stage, protracted descent, failure of descent of the head, an abnormal first stage or the need for mid-pelvic or assisted delivery or once shoulder dystocia has occurred there is inadequate management of the problem and a failure to follow well established protocols to facilitate a normal risk free birth. These protocols should resolve the problem and include :-

  • repositioning the mother
  • applying traction in a horizontal plane
  • applying pressure to the pubic area
  • manoeuvring and changing the baby's position
  • carrying out the McRobert's manoeuvre
  • emergency caesarean section
  • deep episiotomy cut
  • breaking the mother's pelvic bone
  • breaking the baby's clavicle bone on purpose

brachial plexus injury

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The brachial plexus is a network made up from a group of five large nerves (designated C5, C6, C7, C8 and T1) which branch out from the spinal cord and exit between the neck vertebrae (spinal column bones). The purpose of these nerves, some of which eventually terminate at the tips of the fingers, is to transmit micro electrical impulses thereby giving movement and feeling to the arm and hand. The physical arrangement of the network created by this group of nerves is complex and after coming out of the neck, the nerves come together, are then linked and then subsequently further divide before traveling along the muscles and tissues of the arm. The brachial plexus network is in position from the neck, passes under the collarbone and out along the arm at about the level of the armpit and is thus susceptible to injury caused by manual traction of an infants head during childbirth. Brachial plexus injuries can also be caused by car, motorcycle or boating accidents; sports injuries; animal bites; gunshot or puncture wounds; as a result of specific medical treatments/procedures/surgeries or due to certain viral diseases.


diagramatic brachial plexus nerve network

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Erbs palsy is effectively a sub-division of brachial plexus paralysis which if caused during the process of birth may also be known as obstetric brachial plexus palsy and these injuries are classified according to the severity of the injury starting with first degree or neurapraxia, in which the insulation around the nerve called myelin is damaged but the nerve itself is spared through three more increasingly severe stages to fifth degree injuries in which the nerve is completely severed. The severity of a brachial plexus injury depends on a number of factors the most important of which is the number of nerves that have been affected. Of the group of five nerves that can potentially be involved the ones that are most often damaged are the nerves exiting at C5 and C6 which cause the classic 'waiters tip' position of the hand and arm. If all five nerves are affected there may be weakness or paralysis of the entire arm and hand and there may also be an associated Horners syndrome causing the eyelid to droop and the pupil in the eye may be smaller. In addition the condition known as torticollis may be present where the baby faces away from their affected arm and is unable to face forward for any length of time. The next most important factor is the degree of damage suffered by the nerves which are outlined below :-

    Avulsion :-

      This occurs when the nerve is torn from the spinal cord and there is a complete separation or severing. There is no way in which this major injury can be surgically repaired. This is the most severe type of injury and function is completely lost with no hope of recovery.

    Rupture :-

      This occurs when the nerve is torn but not completely severed and there is some chance of a successful surgical repair. There is however no guarantee that full function will be recovered after repair however techniques and success rates are improving year on year.

    Stretching :-

      This often causes damage and injury to the nerves however there is a possibility that there will be spontaneous recovery and that healing will occur without medical intervention.

    Scarring :-

      This can occur on the site of an injury and is known as a neuroma which may interfere with the electrical signals passing along the nerve thereby causing loss of some function to a greater or lesser degree. It may be possible to surgically remove any scar tissue to improve or fully recover motor function.


diagramatic brachial plexus anatomy

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There is a group of diagnostic techniques including nerve conduction tests that may be used to establish the presence of Erbs palsy however the injury is often painfully obvious from a visual examination of the child. Once a child has been diagnosed as suffering from Erbs palsy it is necessary to consider treatment. Babies who suffer from this injury are often left untreated for a few days in the hope that the injury will heal naturally and that a full repair with total return of function will take place spontaneously. In the event of residual disability the condition is usually treated by the use of physiotherapy which is carried out so as to mimic the natural movements of the arm. Most recovery will take place within a few months of the start of treatment however about a quarter of all affected children will have permanent residual disability after the completion of the treatment regime.

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In addition to physiotherapy there are surgical techniques that may help in more severe cases of Erbs palsy and this may include nerve grafts to assist torn or ruptured nerves, muscle transfer into the shoulder to give the arm more movement and tendon transfers to the wrist to assist the hand and fingers to recover some movement.


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Obstetric erbs palsy is relatively rare in the UK occurring in about 1 in 1,800 births. This condition, which is a totally preventable birth injury, occurs more frequently than Downs syndrome, muscular dystrophy and spina bifida yet the general public are largely unaware of it. Many cases are associated with shoulder dystocia with risk factors including babies who are large for their gestational age, excessive lateral traction exerted on the head and neck during delivery, an arm extended overhead in breach presentation during delivery and excessive traction applied to the child’s shoulders during delivery. The most obvious symptoms include the child being unable to extend the arm or rotate the arm from the shoulder or to rotate the arm at the elbow. In addition there may be absence of the biceps reflex absent and sensory impairment. The condition may be confirmed by magnetic resonance imaging (MRI) which shows nerve root damage however electromyography (EMG) which records the extra-cellular field potentials produced by muscles and nerve root studies are not thought to be helpful in determining the extent of the damage. Erbs palsy can lead to lifelong disabilities, extensive therapies multiple surgical interventions, psychological difficulties, pain and financial hardship for both the parents and for the child in adulthood. Children who suffer from this condition can experience increasing disability with age and in due course suffer from arthritis and problems associated with overuse of other body parts in compensation for the disability.

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KLUMPKES PALSY

Erb's palsy involves C-5 and C-6 (cervical vertebra #5 and cervical vertebra #6). The arm hangs limp and is rotated internally. The elbow is extended but flexion of the wrist and fingers are preserved with the palm potentially facing up in a ‘waiters tip’ position. It should be noted that in addition these symptoms may also indicate the possibility of Phrenic nerve injury at C-3, C-4 and C-5. There is another type of brachial plexus injury often associated with Erbs palsy known as Klumpkes palsy which involves C-7 and T-1 (cervical vertebra #7 and thoracic vertebra #1). Klumpkes palsy causes weakness of the wrist and finger flexors and of the small muscles of the hand. It is extremely rare to have true/isolated Klumpke's palsy and the term is sometimes loosely applied when there is a total brachial plexus palsy which occurs when all 5 nerves of the brachial plexus are affected which is often also associated with Horners syndrome and/or Torticollis.

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HORNERS SYNDROME

In some brachial plexus injuries sympathetic nerve fibers that traverse T1 can be damaged. The condition known as Horners syndrome is caused by damage to the sympathetic nervous system and is often associated with injuries to the brachial plexus network of nerves including Erbs palsy which frequently occurs as a birth injury caused by the use of excessive force during delivery most often by inappropriate traction being applied to the head which damages nerves in the area of the shoulder and neck. Symptoms of Horners syndrome include a drooping upper eyelid, elevation of the lower lid, a constricted pupil, delay in dilation of the pupil, an appearance of a slightly sunken eye and a decrease in sweating on the side of the face affected by the condition with occasional differences in eye colour. Horners syndrome is a rare condition which has many causes and is not always as a result of a medical error.

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TORTICOLLIS

The word torticollis comes from two Latin words: torti (twisted) and collis (neck). The following analogy may help to explain this injury. The condition in adults known as 'wry neck' may be described as a temporary form of torticollis. Wry neck is often caused by sleeping in an awkward position as a result of which the neck feels painful and stiff since the muscles are in spasm and the head may be held at an angle until spontaneous recovery occurs over a period of a few hours or a few days. The symptoms of torticollis are somewhat similar and this condition can be a birth injury caused by damage to the muscles of the neck during a vigorous and physical birth. Torticollis is usually noticed between six months and three years of age as a result of the head being tilted to one side. Physiotherapy usually corrects torticollis however there are occasions when surgical intervention is required.

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THE ERBS PALSY GROUP - UK REGISTERED CHARITY 1036423


The Erbs Palsy Group was established in 1991 and offers information to families with children who are suffering from brachial plexus paralysis. The Erbs Palsy Group is a family network that provides support based on the very real experience of bringing up a child who has the disability. Their activities include putting parents, adults and children in touch with each other and advising on benefits and aids for children. In addition they produce a quarterly newsletter/magazine, organise an information day and conference for parents and professionals and arrange an annual social event. This charity distributes fact sheets and their newsletter/magazine includes articles on treatment and benefits and contains letters with case histories, letters from children and a children's page. more....... This independent website neither endorses, nor represents The Erbs Palsy Group, nor has any affiliation or business relationship or any other connection with this charity. ^^ back to the top

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