Brachial Plexus Injuries and Birth Injury

November 15, 2023 | Thomas L. Stroble
Brachial Plexus Injuries and Birth Injury

Childbirth can cause newborns to suffer various kinds of injuries. Brachial plexus injuries are common birth injuries. These are a group of conditions caused by damage to nerves that run into the arm. Damage to these nerve bundles can occur because of improper or negligent actions during delivery by doctors, midwives, or other healthcare providers.

When a birth injury occurs because of a medical professional’s negligence, a child’s family might have the option to pursue financial recovery in a medical malpractice claim.

Retaining legal counsel can help make the claims process less stressful and more efficient for families, as an experienced medical malpractice attorney can provide advice and advocacy that might give families a better chance at recovering compensation for their child’s injury.

Understanding Brachial Plexus Injuries

A brachial plexus injury involves damage or trauma to the bundle of nerves, called the brachial plexus, that runs from the spinal column, through the shoulder, and into the arm.

Brachial Plexus Injuries and Birth Injury

These nerves carry signals from the brain and spinal cord to the muscles in the arm and hand and from sensory nerves in the skin, arm, and hand back to the brain.

The brachial plexus can get injured in various ways, including by putting pressure on, stretching, or severing the nerves. These injuries can cause temporary or prolonged loss of sensation and motor function or paralysis of the arm and hand. In severe brachial plexus injuries, the arm and hand may become permanently disabled.

Common Causes of Brachial Plexus Injuries

Brachial plexus injuries occur during delivery when an infant suffers some form of trauma to the shoulder or arm. While certain factors can increase the risk of a brachial plexus injury, such as multiple births, some injuries occur due to improper treatment decisions made by and actions of a delivery team.

Potential causes of brachial plexus injuries include:

  • Failure to respond to shoulder dystocia, or a condition in which a baby’s shoulders get stuck in the mother’s pelvis
  • Failure to recommend cesarean section due to large fetal size, which comes with a risk of shoulder dystocia
  • Failure to perform an emergency C-section for prolonged or difficult labor or maternal exhaustion
  • Improper use of delivery tools like forceps and vacuum extractors, including pulling on an infant’s head with tools or making multiple attempts with tools instead of proceeding to a cesarean section
  • Improper position of an infant for delivery or failure to identify improper positioning, which can lead to breech birth (delivery that occurs other than head-first)

Conditions Caused by Brachial Plexus Injuries

Brachial plexus injuries can cause prolonged or permanent conditions or complications for an infant.

Some of the most common brachial plexus injuries include:

  • Neuropraxia: Neuropraxia is a condition where nerves become stretched or compressed to the point of causing injuries and symptoms. Neuropraxia can cause a burning or stinging sensation in the neck, shoulder, and arm, along with weakness or numbness in the affected arm. 
  • Neuroma: This condition involves nerve tissue attempting to repair itself from a cut or tear, which can form a painful knot on the nerve bundle. Treatment may include surgery to remove the scar tissue and either cap the nerve or reattach it to another nerve. 
  • Rupture: A rupture injury is a partial or complete tear that causes some degree of paralysis of the affected parts of the arm. Depending on the severity of the injury, a patient may benefit from surgical treatment, although more severe tears may never fully heal. 
  • Avulsion: In an avulsion, the roof of the nerve bundle entirely severs from the spinal cord. Due to the extreme difficulty of reattaching a nerve bundle to the spinal cord, avulsions frequently lead to permanent weakness, numbness, or paralysis. 
  • Erb’s Palsy: Also called Erb-Duchenne paralysis, Erb’s palsy is a condition resulting in weakness or loss of motor function in the hand, arm, and shoulder. Erb’s palsy may occur due to stretching or tearing of the brachial plexus nerves.
  • Klumpke’s Palsy: Also called Klumpke’s paralysis, Klumpke’s palsy affects the muscles of the hand, wrist, and forearm. This condition occurs due to stretching or tearing of various nerves in the brachial plexus connecting to the forearm and hand. 
  • Global Palsy: An infant may suffer a global brachial plexus injury or global palsy when they sustain injury to all five nerve bundles of the brachial plexus. Symptoms of global palsy include loss of motor function in the hand, arm, and shoulder, frequently accompanied by loss of sensation in the arm.

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How Do You Know if Your Child Has Suffered a Brachial Plexus Injury?

Unfortunately, a newborn cannot verbalize the symptoms they experience due to a brachial plexus injury. Since a brachial plexus injury can cause numbness, infants who have suffered an injury may not cry as one might expect from a severe injury. As a result, parents and healthcare providers should watch newborns and infants for signs of a potential brachial plexus injury.

Signs of a brachial plexus injury may become apparent right after delivery, although in some cases, it can take weeks or months for them to become noticeable.

Common symptoms of brachial plexus injuries include:

  • The baby holds their arm or hand in an odd or awkward position, such as curling the forearm inward or curling the hand down at the wrist
  • The baby’s arm hangs limply
  • The baby has trouble moving their shoulder, arm, or hand
  • The baby doesn’t react to touch, heat, or cold on their arm or hand
  • The baby’s elbow joint feels tight and difficult to flex
  • The baby’s shoulders appear oddly positioned or uneven

Failing to meet motor-function-related developmental milestones should also alert parents and healthcare providers to a possible injury.

Treatment and Long-Term Care for Brachial Plexus Injuries

Treatment for brachial plexus injuries depends on the type and severity of an infant's injury. Because some brachial plexus injuries heal on their own, treatment may simply involve medical observation over the first few months of a baby’s life to ensure that symptoms improve. However, doctors may recommend more direct treatment for more severe injuries or injuries with slow improvement.

A doctor may recommend physical/occupational therapy for a brachial plexus injury, especially if an infant’s prognosis indicates a prolonged recovery period. Physical or occupational therapy can help infants maintain or regain arm and hand strength and prevent tightening of muscles and joints that might require more intensive rehabilitation.

Therapists will teach parents a range of motion exercises to perform at home with their children to maintain normal movement and range of motion. However, some children might need a longer course of physical/occupational therapy to learn skills that help them adapt to permanent physical disabilities caused by the injury.

When infants show little or no improvement by age three to six months, doctors may recommend surgical treatments to help restore feeling and function for infants.

Standard surgical options for brachial plexus injuries include:

  • Nerve surgery: Doctors may repair damaged nerves that have not appropriately healed by grafting nerves from elsewhere in the body or attaching nerve fibers from undamaged nerves.
  • Osteotomy: A procedure that involves cutting and reorienting bones to better position the arm and hand and improve function.
  • Tendon transfer: A tendon transfer involves separating a tendon from a healthy muscle from its standard attachment and reattaching it to a new location so that the healthy muscle can assist a weaker muscle.
  • Open shoulder joint reduction: Surgeons perform this procedure to tighten loose tissues around the shoulder joint to address prolonged muscle weakness that has or could lead to shoulder instability or dislocation.

While physical/occupational therapy and surgeries can restore most or all of an infant’s lost motor function, more severe brachial plexus injuries may require children to undergo prolonged rehab to build up strength and range of motion.

Prompt treatment can give children the best chance of a significant or complete recovery from a brachial plexus injury. However, some children never fully recover and may require adaptive tools to accommodate permanent disabilities.

Liability for Birth Injuries That Damage the Brachial Plexus

Not all cases of brachial plexus injuries occur due to a healthcare provider’s negligence. However, when a doctor, midwife, or other medical professional makes treatment decisions or actions before or during delivery that cause an infant to suffer a brachial plexus injury, a family might have a legal claim to hold that medical provider liable.

Medical negligence or malpractice occurs when a healthcare provider’s treatment fails to comply with the applicable standard of care in a patient’s case. Though the specifics of the standard of care vary from patient to patient, experts generally define the standard of care as the decisions or actions that other medical professionals of similar training and experience would make in the patient’s case.

Thus, a healthcare provider may bear liability for a child’s brachial plexus injury when they make treatment decisions or actions that their colleagues would not, and an infant gets injured as a result.

What Compensation Can Your Family Seek for Your Child’s Brachial Plexus Injury

A medical malpractice claim might allow your family to seek the financial resources you need to provide care and support for your child’s brachial plexus injury.

Compensation in a brachial plexus birth injury claim may include money for your child’s:

  • Medical treatment and rehabilitation, including physical/occupational therapy, surgeries, and mobility/adaptive equipment
  • Costs of long-term care and support for permanent disabilities that result from the brachial plexus injury
  • Lost future earning abilities caused by severe permanent disabilities
  • Non-economic losses such as physical pain, emotional suffering, or reduced quality of life due to physical disabilities or embarrassment/humiliation from disfigurement

Michigan law limits the amount of money recoverable in a medical malpractice claim for non-economic losses. The current cap is $500,000.

Pursuing a Birth Injury Claim

Under Michigan’s statute of limitations on medical malpractice claims, a family may have until a child’s tenth birthday to file a lawsuit for a brachial plexus injury sustained at birth. However, a family should not delay talking to a medical malpractice attorney about a potential case.

The longer a family delays a legal claim, the longer they must wait to receive any potential compensation in a malpractice claim and the greater the risk that key evidence or witness testimony gets lost.

Michigan law also requires a family seeking to file a medical malpractice lawsuit to send notice of their claim to the healthcare provider(s) allegedly responsible for a child’s brachial plexus injury at least 182 days before filing the lawsuit.

The notice must state the factual basis for the malpractice claim, the claimed applicable standard of care in the child’s case, how the healthcare provider breached the standard of care, and how that breach caused the child’s brachial plexus injury.

Within 56 days of this notice, a family and the providers who received notice of the claim must exchange or provide access to any relevant medical records in each party’s possession or control.

A healthcare provider must submit a response to the notice within 154 days of receipt, which must state the factual basis for the provider’s defense, the standard of care the provider believes applied, how the provider believes their actions complied with the standard of care, or how the provider believes their treatment did not cause the child’s injury.

Once the 182 days expire or the provider expressly declines to offer a settlement, the family may file their lawsuit if the limitations period has not expired.

A birth injury lawsuit also requires a family to file an affidavit certifying that a medical professional has reviewed the family’s claim and providing the professional’s opinion as to the applicable standard of care, how the provider’s conduct failed to comply with the standard of care, the actions the provider should have taken to comply with the standard, and how the provider’s breach of the standard of care caused the brachial plexus injury.

How Can a Lawyer Help You Seek Financial Recovery for Your Child’s Birth Injury?

Thomas L. Stroble, Medical Malpractice Attorney in Michigan
Thomas L. Stroble, Medical Malpractice Lawyer

Pursuing a malpractice claim after your child has sustained a brachial plexus injury during delivery is a complex process. You deserve to devote your time and energy to getting your child the care they need to recover. A birth injury attorney can allow you to focus on your child’s recovery by handling the details of your family’s legal claims.

An experienced personal injury attorney can investigate your family’s case to recover evidence that might help prove your child’s injury occurred because of negligent care or treatment decisions. A lawyer can identify parties that might bear liability for your child’s injuries and medical expenses and help your family document ongoing and future anticipated treatment and rehabilitation costs.

Your legal counsel may communicate and negotiate with insurance adjusters, hospital representatives, and defense attorneys on your family's behalf to protect your interests and advocate for compensation and justice for your child and your family.

Thomas L. Stroble Author Image

Thomas L. Stroble


Mr. Stroble is a highly accomplished graduate of Michigan State University, with degrees in both science and law. He specializes in commercial lawsuits and personal injury cases. Licensed to practice law in Michigan and even the U.S. Supreme Court, he’s a well-qualified legal expert. Besides his career in law, he loves outdoor activities and volunteers as a part-time police officer in Birmingham.

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