Birth related brachial plexus palsy refers to an injury occurring in the perinatal period to all or part of an infant’s brachial plexus (the network of nerves connecting your spine to your upper limbs). Birth related brachial plexus palsies can be defined as either Erb’s palsies or Klumpke’s palsies. Erb’s palsies are injuries occurring in the upper brachial plexus, whereas Klumpke’s palsies are injuries which occur in the lower brachial plexus. Various factors can increase an infant’s risk of suffering a brachial plexus palsy during childbirth. Improper, unskilled or negligent treatment by a medical professional can also cause an infant to suffer a brachial plexus palsy.
The brachial plexus
The brachial plexus is a network of nerves near the neck that sends signals from your spine to your upper limbs including your shoulders, arms, forearms, hands, and fingers. The brachial plexus is responsible for movement of and sensation in these areas.
Injury to the brachial plexus
A brachial plexus injury occurs when nerves are damaged by having been constricted, strained, or, in extreme cases, severed from the spinal cord. Brachial plexus injuries are categorized in accordance with the severity of damage done to the nerves, as follows:
Avulsion – Avulsion refers to a complete tearing of the nerve root from the spinal cord. In such instances, surgical intervention is not often a treatment option.
Rupture – A Rupture is often as serious as an avulsion; however, a rupture, which is a tear of the nerve root beyond the spinal cord, can sometimes be repaired with surgical intervention.
Neurotemesis– Neurotemesis occurs when the entire nerve has been divided.
Axonotemesis– Axonotemesis occurs when the axons (the long threadlike part of a nerve cell along which impulses are conducted from the cell body to other cells) have been severed.
Praxis/Neurapraxia – Praxis/Neurapraxia occurs when a nerve is not torn but has been damaged from stretching.
Neuroma – Neuroma occurs when scar tissue has formed around the injury and signals from the nerve to the muscle are restricted as a result.
Types of brachial plexus injuries
Erb’s palsy
Erb’s palsy is caused by damage to the upper C5 and C6 nerves. Partial or full paralysis of the arm can occur. The injured is unable to raise their arm which hangs to the side. In some instances, the affected arm is noticeably smaller than the unaffected arm.
Klumpke’s palsy
Klumpke’s palsy is caused by damage to the lower C8 and T1 nerves. This results in paralysis of the forearm and hand muscles. Klumpke’s palsy can give the appearance of a clawed hand as the wrist and fingers are affected.
Factors that can increase an infant’s risk of suffering a brachial plexus injury
Several factors can increase an infant’s risk of suffering a brachial plexus injury during childbirth, including:
- Maternal obesity;
- Maternal diabetes;
- Fetal macrosomia (large infant weight);
- Prolonged labour;
- Shoulder dystocia (a complication during delivery in which an infant’s shoulders become stuck in the mother’s pelvic area); and
- A breech position.
Improper, unskilled or negligent treatment by a medical professional
The presentation of shoulder dystocia or a breech position during delivery increases an infant’s risk of serious complications such as brain injury or death. With proper medical care and attention, these emergency situations can be foreseen and appropriately managed. Medical professionals can employ specific maneuvers and may utilize birth assisting tools such as forceps or a vacuum extractor to reduce the risk of serious complications.
However, improper use of these techniques and medical aids can cause stretching or tearing of an infant’s nerves resulting in permanent, serious injury such as Erb’s palsy or Klumpke’s palsy. These preventable conditions often require extensive medical treatment including physiotherapy, surgery, and professional counselling to maximize a child’s potential for recovery and wellbeing.
If your child has been diagnosed with a brachial plexus injury such as Erb’s palsy or Klumpke’s palsy and you suspect medical negligence as a cause, please contact Wagners at 902-425-7330, toll-free at 1-800-465-8794 or via email at seriousinjury@wagners.co
