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Erb's Palsy Missouri Birth Injury Attorney

Erb's Palsy was discovered by German neurologist Dr. Wilhelm Heinrich Erb in the 1800s. A nerve injury, Erb's Palsy occurs when the brachial plexus, a group of nerves that branch from the spinal cord to the arm pit area, is stretched or torn during the birth process. Damage to these nerves will result in loss of sensation, weakness and even paralysis of the affected shoulder and upper arm.

Causes of Erb's Palsy

During childbirth, after the infant's head clears the birth canal, the infant's shoulders can sometimes become lodged in the birth canal. Also called shoulder dystocia, this can happen if the infant is too large to comfortably fit thorough the birth canal.

By pulling on the infant's head, the nerves associated with the shoulder lodged in the birth canal can be stretched or severely injured. The group of five nerve fibers in this region is called brachial plexus, or Erb's Point. The brachial plexus can suffer several different types of injuries:

Avulsion
The nerve is completely torn and is no longer attached to the spine

Rupture
The nerve is completely severed, but not at the spine. This causes the development of scar tissue, or neuroma

Neuroma
Developing scar tissue around the nerve. The scar tissue prevents the nerves from effectively conducting signals from the spine to the arm.

Praxis
The nerve is stretched and injured, but there is no tearing. In this instance, the nerve has a chance of healing on its own over time, or it may develop neuroma during the healing process

Symptoms of Erb's Palsy

Depending on the severity of the injury, there will be weakness or even paralysis in the injured shoulder or arm. The injured arm is typically limp with the forearm turned inward and presents with a bent wrist. Infants with Erb's Palsy will be unable to lift the injured arm, even when startled. This startle reflex, also called the Moro reflex, causes an infant to throw his or her arms to the side, with palms up and fingers open. When an infant with Erb's Palsy is startled, the injured arm may not show any movement. It will be held tight to the body with the elbows flexed. In addition, a severe injury may even cause the infant's eyelid on the same side as the injury to droop.

Risk Factors for Erb's Palsy

Risk factors that can result in Erb's Palsy include:

  • A prior birth where the infant experienced shoulder dystocia, even if it did not result in Erb's Palsy
  • Larger babies, especially those born to mothers with diabetes or gestational diabetes
  • Babies with above average birth weight, or a birth weight of 8lb 13 oz or higher
  • Smaller mothers, particularly those with smaller pelvises
  • Labors where the second stage of labor (when the mother starts to push) lasts longer than 2 hours
  • Breech position births

With time and medical advances, improved delivery techniques have helped prevent many injuries of this nature. At present, if shoulder dystocia should occur during delivery, there are specific actions that the obstetrician can take to remedy this situation. Some of these techniques include:

Gaskin Maneuver
By placing the birth mother on her hands and knees, the diameter of the pelvis is changed and may make delivery easier. This may not be possible if the mother has received an epidural.

McRobert's Maneuver
Mother's knees are pushed back and down to open the pelvis even more. This procedure may reduce shoulder dystocia in half.

Woods Maneuver
Also called the corkscrew, two fingers are placed on the baby's shoulders and pushed in 180 degrees.

Rubin Maneuver
Similar to the Woods maneuver where two fingers are placed on the baby's shoulders. The fingers are pushed in the direction of the baby's eyes instead.

Suprapubic Pressure
Instead of putting pressure on the uterus, pressure is placed on the pubic bone to allow the infant to exit the birth canal

Zavanelly Maneuver
Normally used if the baby presents in a breech position, this can be a dangerous maneuver. The baby is pushed back into the vagina, and a cesarean is performed to remove the baby.

Steps to prevent Erb's Palsy

In preventing Erb's Palsy, most medical professionals suggest:

  • Maintain good health care during pregnancy
  • If you have diabetes or gestational diabetes, be vigilant to maintain proper blood sugar levels through diet and medication
  • Be informed of the risks that could lead to shoulder dystocia. Should you know your infant is at risk of shoulder dystocia, begin exploring options with your obstetrician such as planned cesarean, or an induced delivery.

Diagnosing Erb's Palsy

Tests such as an x-ray, an electromyography (EMG) or a nerve conduction study (NCS) are necessary to determine an injury of this nature. Since it is possible for an infant with Erb's Palsy to recover in time, it is necessary for the baby to receive frequent evaluations. Therapy such as exercises and slings or splints may be used as part of the recovery process.

Treatments for Erb's Palsy

If the injury is a stretched brachial plexus or a mild tear, Erb's Palsy has been known to heal on its own. However, it is recommended the infant receives physical therapy to prevent the arm from stiffening or contracting, and to keep adequate muscle tone.

Should the damage be more severe, surgery may be required. However, surgery may not completely address the situation, and may still result in an arm that is weak with limited range of motion. Also, the recovery time on a surgery of this nature may be lengthy since nerve injuries may take several years to completely heal.

Millikan Wright LLC has experience in complex medical malpractice cases. Our results demonstrate our committment to helping families recover and heal from an injury or wrongful death. We work only on a contingency fee basis, which means no cost to you until we secure a financial settlement. If we do not win the case, we absorb the entire cost. To arrange a no-cost consultation and learn how you may be entitled to compensation, contact us online or call our personal injury lawyers at 877.621.0622 (314.621.0622 in St. Louis).

The Missouri Injury Attorneys of Millikan Wright LLC focus serving the needs of the greater St. Louis Metropolitan area. On the Missouri side, our lawyers represent people injured in St. Louis city, St. Louis county, Jefferson county, Franklin county, St. Charles county, and Lincoln county. On the Illinois side, our attorneys represent people hurt in Madison county, St. Clair county and Monroe county.