Brachial Plexus Injury / Erb's Palsy
The network of nerves that supplies signals from the spinal cord to the shoulder, arm, and hand is referred to as the brachial plexus. During birth, brachial plexus injuries can occur in conjunction with "shoulder dystocia". "Dystocia" is a medical term which means an abnormal or difficult childbirth or labor. Shoulder dystocia is a complication whereby the shoulder of the infant cannot pass by the pubic symphysis.There are risk factors for shoulder dystocia which doctors should take into account during the prenatal care period. If sufficient risk factors exist, a reasonable physician may recommend a cesarean section be performed to avoid shoulder dystocia. This is one method reasonable doctors use to avoid risk of injury to the baby or the mother.
When shoulder dystocia occurs, there are several steps that a reasonable doctor should take to attempt to dislodge the shoulder and deliver the baby. One thing a doctor should not do is to apply excessive traction to the fetal head, which often leads to brachial plexus injury. Further, a reasonable health care provider should not apply what is called "fundal pressure". This is where a health care provider pushes on the top of the mom's tummy. Although fundal pressure is often proper, when it is applied in the presence of a shoulder dystocia, studies have found it serves only to further impact the shoulder into the pubic symphysis.
The results of a brachial plexus injury can be devastating: a limp or paralyzed arm, lack of muscle control in the arm, hand, or wrist, and lack of feeling or sensation in the arm or hand.
Four categories of brachial plexus injuries:
| avulsion | if nerves are torn from the spinal cord, it is referred to as an "avulsion" - this is the most severe brachial plexus injury |
| rupture | when nerves are torn somewhere other than the point of spinal attachment, it is called a rupture |
| neuroma | on occasion, the nerve will try to heal and scar tissue will grown around the injury ... this can put pressure on the injured nerve and prevent the nerve from sending signals from the brain; |
| neuropraxia | the nerve may also be damaged by being stretched ... when this happens, the nerve is damaged, not torn |
If your child suffers from a brachial plexus injury and want to know whether the doctor or nurses contributed to the problem, please give us a call at 866-KYTRIAL or contact us online.