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Erb’s Palsy is a medical condition causing paralysis of the arm due to nerve damage. It usually occurs during a difficult childbirth as a result of an injury to a baby’s shoulder. Baby’s with Erb’s Palsy may be able to make a substantial compensation claim if their delivery was negligently managed.
Minton Morrill Solicitors have a strong track record of successfully pursuing Erb’s Palsy compensation claims. Our specialist team have the experience and expertise to help your child get the compensation they deserve so that they have the right support to help with their condition.
To find out more, or for a free and confidential initial consultation with our specialist lawyers, call and speak to one of our expert Erb’s Palsy solicitors on 0113 245 8549 or use our contact form.
What is Erb’s Palsy?
Erb’s palsy or Erb-duchenne palsy, also known as brachial plexus palsy, is where there is paralysis of the arm caused by injury to the upper group of the arm’s main nerve. Specifically where there is severing of the upper trunk C5-C6 nerves which form part of the brachial plexus. Erb’s Palsy is usually caused during childbirth when a baby’s shoulder becomes stuck after their head is delivered. This is known as Shoulder Dystocia.
Babies who are born with Erb’s palsy may not be able to move their shoulder but may be able to move their fingers. If both the upper and lower trunk nerves are stretched and damaged, the condition is usually more severe than an Erb’s palsy diagnosis and is described as global or total brachial plexus birth injury affecting the shoulder, arm and hand.
What Causes Erb’s Palsy?
Erb’s palsy is often caused when a baby’s neck is stretched to the side during a difficult child delivery. Excessive force by the medical staff in delivering the baby can cause injury to the delicate brachial plexus nerves. If a doctor, for example, pulls improperly or too hard during delivery this increases the risk of injury such as lots of twisting, turning, pulling and tugging.
Other causes include:-
- Forceps: - Birth assisted tools, such as forceps or vacuum extraction (ventouse), may be used improperly by the operator including performing inappropriate manoeuvres.
- Failure to properly monitor fetal size and to perform a caesarean section in large infants. If a baby is unusually large and/or in the breach position, the chances of an Erb’s palsy injury increase. It ought to be possible for a Doctor to be able to tell when a baby is in the breach position and also what the baby’s estimated weight is. The failure to monitor this can result in an Erb’s palsy injury.
- Mothers with a small pelvis can be prone to have babies that may get stuck. It is again important for this to be reviewed alongside the anticipated size of the baby.
- In the event of an Obstetric emergency where there is fetal distress (the baby is being starved of oxygen), there may be a need to deliver the baby very quickly; the speed of which may result in an Erb’s palsy injury.
- Where a mother has previously given birth to a baby that has suffered shoulder dystocia, the likelihood is that such an injury may well be more common with the next birth. This ought to result in a detailed discussion about the mode of delivery.
Avoiding Erb’s Palsy Injuries – Best Practice
Best practice to manage shoulder dystocia and try to avoid Erb’s Palsy injuries has led to the McRoberts procedure being used. To perform the McRoberts manoeuvre properly requires one person to manage the delivery, two people to abduct and flex the mother’s hips into the McRoberts position and possibly another, fourth person, to apply suprapubic pressure to the mother.
Where there are less than 3 birth attendants, it is less likely that the important McRoberts position has been properly performed. If this initial manoeuvre is unsuccessful, the next step is an internal manoeuvre to rotate the baby’s shoulders. This can include Wood’s Screw manoeuvre, which can be difficult to execute properly.
What Muscles Does Erb’s Palsy Affect?
In most cases of Erb’s Palsy or brachial plexus birth injury, it is the upper nerves that are affected.
There are 4 types of nerve injuries which are:-
- Neuropraxia. This is a stretch injury which shocks but does not tear the nerve and is the most common type.
- Neuroma. A stretch injury that damages some of the nerve fibres and may result in scar tissue.
- Rupture. A stretch injury which causes the nerve to be torn apart and will not heal on its own.
- Avulsion. This happens when the nerve is torn from the spinal cord.
Nerve eruptions and avulsion are the most serious type of nerve injury and may result in the need for a nerve graft from another nerve to restore function.
How is Erb’s Palsy diagnosed?
A Paediatrician is usually the type of doctor to make a diagnosis of Erb’s Palsy. This may be done by assessing a baby’s clinical signs, but also with nerve conduction studies, X-rays and Ultrasound scans.
A child may suffer from some of the following symptoms:-
- Weakness in one arm.
- Loss of feeling in the arm.
- Floppy arm.
- Partial or total paralysis of the arm.
How is Erb’s Palsy Treated?
Babies with Erb’s palsy injuries may recover from their injuries on their own (although it can take up to 2 years for a complete recovery) but other babies are sadly left with lifelong problems.
Treatment options can include:-
- Physical therapy such as Physiotherapy, which is the main treatment for Erb’s palsy.
- Surgical treatment such as a nerve graft or a nerve transfer. Many children with Erb’s palsy injuries will continue to have some weakness in the shoulder, arm or hand and it may well be that other surgical procedures have to be performed which might improve function.
Erb’s Palsy Medical Negligence Claims
Different medical theories and expert opinions about the relationship between birth, management of shoulder dystocia and Erb’s palsy injuries have been discussed for the last two decades.
Until very recently, all obstetric brachial plexus injuries (including Erb’s palsy) were thought to be caused by excessive traction applied by medical staff during a difficult delivery of a baby’s shoulders. However, more recently, there have been increasing reports that shoulder dystocia can occur even when there is no excessive traction of the baby.
Literature on the causation of obstetric brachial plexus injury and Erb’s palsy has influenced judicial decisions. Based upon this literature and case law, a template was proposed to provide guidance for those assessing issues of causation in clinical negligence claims.
This includes the following points:-
- In the absence of shoulder dystocia it is difficult to imagine how the delivery management could have been improved to prevent an Erb’s palsy injury and, therefore, the injury is more likely to be due to the labour itself rather than any failure on the part of medical staff.
- At least 30% to 40% of Erb’s palsy injuries affect a baby’s posterior shoulder in labour and this is not considered due to any action by medical staff. Anterior shoulder injuries are, however, more likely due to inappropriate actions by staff. Considering the position of the baby’s arm is, therefore, of crucial importance in avoiding the injury and reviewing any negligence claim.
- The length of the second stage of labour. A short second stage (less than 20 minutes) is more common in cases of Erb’s palsy injury occurring in the absence of shoulder dystocia. This suggests that propulsive forces may be responsible for the injury rather than staff error.
- Excessive traction increases the risk of injury with medical literature suggesting that traction imposed on the baby’s head is strongly associated with an Erb’s palsy injury.
- There is evidence that simulation training can improve performance in the management of shoulder dystocia deliveries with staff being trained to reduce the total force used during the delivery to avoid Erb’s Palsy injuries. Poor training increases the chance of injury occurring.
- McRoberts manoeuvre. This is the best practice first step manoeuvre for the safe management of shoulder dystocia situations, as enshrined in NHS protocols and guidance.
- The McRoberts manoeuvre is often combined with supra-pubic pressure, ideally to be applied from the side of the fetal back. This can abduct the shoulders as well as help with decent of the pubic symphysis to deliver the baby.
- If the initial manoeuvres are unsuccessful at delivering the baby, the next step is an internal manoeuvre to rotate the baby’s shoulders into an oblique angle or deliver the posterior arm. This depends upon clinical circumstances and individual experience.
Our Erb’s palsy specialist lawyers have expertise in assessing all of these and other relevant factors which may well have caused or contributed to the Erb’s palsy injury.
Pursuing an Erb’s Palsy Medical Negligence Claim
Our medical negligence team have extensive experience in successfully pursing Erb’s palsy compensation claims. We seek and obtain important answers about what has gone wrong during childbirth and whether your child’s injury could have been avoided. When failings have occurred, we have a proven track record of obtaining the maximum level of compensation for your child.
We will carefully talk you through each stage of the litigation in an Erb’s Palsy compensation claim.
Usually, we will take a detailed witness statement from you and obtain the relevant medical records. On review of these, it may be necessary to obtain expert evidence from an Obstetrician, Midwife, Paediatrician and possibly a Plastic Surgeon and Orthopaedic Surgeon to provide their view on the cause of the Erb’s palsy injury and whether it could have been prevented with better medical care.
It may also be necessary to involve a specialist Barrister if the evidence suggests there has been sub-standard care so that the strength of a case and the experts’ views can be fully explored. If the case is supported by the experts, we will invite the Hospital to accept responsibility for the poor care. If they try and defend the case without good reason, it may be necessary to take them to Court.
Compensation for an Erb’s Palsy Injury Case
If you can prove sub-standard care led to an avoidable Erb’s Palsy injury, your child is likely to be entitled to claim compensation. Different types of compensation may be payable to your child by the Defendant dependent on the severity of their injury and their needs.
- General Damages for the injury itself, determined by the severity of the injury.
- The cost of Physiotherapy.
- The cost of Occupational Therapy.
- The cost of Hydrotherapy.
- The cost of surgery, such as nerve graft or tendon/muscle release.
- Loss of earnings.
- Handicap on the open labour market.
- Aids and equipment.
Other heads of damage for compensation are likely to be sought in addition to these examples above and our specialist Erb’s palsy lawyers will carefully review and advise you about these.
Time Limits for Pursuing an Erb’s Palsy Claim
In claims involving children the time limits for pursing a medical negligence claim are different to adults. The limitation period for children to pursue a claim stemming from their birth, for example, is when they turn 21 years old, if they have mental capacity. Limitation can be complicated and it is important that you speak with our specialist Erb’s palsy solicitors so that we can advise you on this. Even if your child is over the age of 21 it may still be possible to successfully pursue a case.
Our Successful Erb’s Palsy Compensation Claims
We have substantial experience of successfully recovering significant compensation on behalf of clients who have suffered an Erb’s palsy injury. We have set out three examples of this below.
- Megan (name changed to protect client confidentiality)
Megan is a young girl who sustained an Erb’s palsy injury at her birth after her mother went into cardiac arrest during labour. The cardiac arrest caused Megan to be deprived of oxygen before she was born which triggered an obstetric emergency necessitating immediate delivery of Megan. Because of this rushed emergency delivery, Megan sustained a major brachial plexus/Erb’s palsy injury to her left arm resulting in significant weakness. She required surgery on two subsequent occasions to try and rectify the injury but was still sadly left with significant disability likely to affect and limit how she lives in the future.
This was a complex medical negligence claim requiring careful consideration with medical experts in the fields of Obstetrics, Anaesthesia and Orthopaedic Surgery. The expert evidence was that the Hospital had been negligent in inserting an epidural into Megan’s mother and had further failed to recognise the epidural had been incorrectly inserted which caused the cardiac arrest. The Obstetric medical expert said that if this mistake had not happened, Megan would not have been delivered in an emergency situation and, therefore, would not have sustained a serious Erb’s palsy injury. The Hospital initially defended the claim, but with perseverance and hard work we were able to succeed with the claim and obtain significant compensation for Megan for the lifelong Erb’s Palsy injury to her left arm.
- Sally (name changed to protect client confidentiality)
Sally is a young girl who sustained an Erb’s palsy injury. She was almost completely paralysed in her right arm and required intensive physiotherapy, particularly from her mother, for the first 8 months of her life. Sally then started to use her arm more frequently but continued to experience weakness in her arm. She had difficulty with dressing, brushing her hair and lifting heavy objects and suffered numbness and aching in her arm and shoulder. Sally was also not able to put her right hand behind her head.
Although Sally sustained an injury at her birth, it was not clear whether this was an Erb’s Palsy injury that could have been avoided. Having obtained the medical records, expert evidence was sought from a Consultant Obstetrician and Gynaecologist. His expert opinion was that excessive traction had been applied during Sally’s assisted instrumental delivery. The medical records also noted the right arm was anterior at the time of delivery which is often a sign that an Erb’s Palsy injury is more likely to have been caused by inappropriate actions from medical staff. Further, there was a relatively lengthy final stage of labour where Sally was born about 8 minutes after delivery of the head. Excessive traction was likely to have been greater along with the time it took for the delivery to be performed.
The claim was not defended by the Hospital and it was possible to reach a negotiated settlement that was also approved by the Court. This ensured Sally was appropriately compensated for the Erb’s palsy injury which she had sustained at birth.
- Thomas (name changed to protect client confidentiality)
Thomas suffered Erb’s palsy that had lasted for more than 12 months involving the C5 and C6 nerve roots. He needed surgical exploration and repair of the right brachial plexus with nerve graft to the C5 and C6 nerve roots. He then underwent a further surgical procedure (a right functional gracilis muscle transfer) to improve right elbow flexion. Despite this, Thomas suffered significant limitation of movement of his right arm and weakness of the right shoulder and elbow. This meant he was unable to actively extend his right wrist. He needed help with dressing, doing up buttons, pulling zips, using cutlery and cutting up food. The weakness in his right upper half meant he struggled to lift objects. He also had surgical scars and the medical evidence indicated he required further surgery and would have a lifelong handicap that would result in his being disadvantaged in his future career as an adult.
Following the involvement of our specialists Erb’s palsy compensation team of lawyers, it became apparent that excessive traction had been used during the delivery of Thomas’ shoulders which included damaging, twisting and/or jerking movements as well as failing to perform the appropriate manoeuvres to ensure safe delivery of the shoulders. The Hospital conceded fault and we worked together with Thomas’ family to obtain substantial financial compensation for the avoidable birth injury that he suffered and his lifelong disability.
Why Choose Us?
Our team of medical negligence solicitors has a lot of experience recovering substantial compensation for Erb’s palsy injury claims and in finding out what went wrong with a child’s care.
Contact the team at Minton Morrill if you, your child, or someone you know has suffered an Erb’s Palsy or brachial plexus injury during childbirth. We can help you to assess whether there is likely to be a claim for compensation to ensure they receive damages if their injury occurred as a result of sub-standard medical care.
For more information, or for a confidential free initial consultation, call one of our experts on 0113 245 8549 or use the contact form below.
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