Can you claim compensation for Erb’s palsy?
A claim for compensation may be possible if the Erb’s Palsy was the result of medical negligence during the management of the pregnancy, labour and/or birth.
Clinical (or medical) negligence is a serious breach of the duty of care that medical professionals (such as midwives and obstetricians) legally owe their patients. The breach of care must have caused or materially contributed to the baby’s injury.
For example, compensation may be claimed for Erb’s palsy if there was a failure to organise a caesarean section when shoulder dystocia should have been foreseen or in a case where the guidelines and procedures for managing shoulder dystocia are not followed.
Other circumstances where an Erb’s palsy claim may be possible include:
- A use of excessive force during the delivery
- A failure to carry out a caesarean section despite clinical evidence
- A failure to evaluate a baby’s weight and size before delivery if there are clinical signs of a large baby and/or a history of large baby pregnancies
- A failure to diagnose and treat maternal diabetes
- A failure to follow best practice procedures for shoulder dystocia
What is Erb’s palsy?
Erb’s palsy is a condition caused by an injury to a baby’s upper arm during delivery. The impact of the injury can vary from mild to severe and will depend upon the seriousness of the damage.
The condition occurs when the nerves in a baby’s upper arm are harmed at Erb’s point. This point is close to the baby’s neck where the fifth and sixth cranial nerves join to form the top of the brachial plexus.
If the nerves of the brachial plexus are damaged it can affect the spinal cord’s ability to send nerve impulses to the arm, wrist, hand or fingers. Babies with the condition usually cannot move their shoulder or upper arm. It can look as though the limb is paralysed but they may still be able to wiggle their fingers.
One or two in every 1,000 babies can be affected by the condition.
Erb’s palsy refers only to brachial plexus damage to the upper nerves. If nerves on both the upper and lower ends of the brachial plexus are stretched and injured, the result can lead to a more severe condition known as total or global brachial plexus palsy.
What causes Erb’s palsy?
Erb’s palsy is most commonly associated with shoulder dystocia but there can be other causes for the condition.
Shoulder dystocia is a type of obstructed labour. After the delivery of the head, the shoulder of the baby cannot pass below – or requires force to pass below – the pubic symphysis, which is the cartilaginous joint that joins part of the left and right pubic bones. With the shoulder stuck, there is a risk that the nerves in the baby’s neck can be stretched, ruptured or ripped when significant force is used to free the baby from the birth canal.
Other causes can include:
- The use of forceps or other birthing tools
- Infants in the breech position
- Large baby size
- Small mother size
- Excessive maternal weight gain
- Infants with high birth weight
- Second stage of labour lasting over an hour
Excessive movement and stretching the baby’s head and neck during delivery can result in some cases of Erb’s palsy, but the chances of developing the condition triple with shoulder dystocia.
What are the symptoms of Erb’s palsy?
The symptoms can vary depending on the severity of the condition. The classic symptom associated with Erb’s palsy is the ‘waiter’s tip hand’ but the impact of the injury can vary from small signs of weakness in the limb to paralysis.
The most common symptoms are:
- A limp arm held to the side or the body and bent at the elbow
- The baby has a weak hand and finds it hard to grip
- Partial or full paralysis
- Loss of sensory function in the arm
- Loss of movement in the upper arm
- Poor circulation
- Poor nerve and muscle development
The ‘waiter’s tip hand’ is a severe symptom and the result of catastrophic damage to the nerves of the upper arm. It gets its name from the position that the arm and hand are held in after injury. The arm hangs down close to the body and the hand is pushed back with the palm up.
How is Erb’s palsy treated?
The treatment for Erb’s palsy will vary depending on the severity of the injury to the baby.
Surgery may be required in some circumstances. This might be the case if the nerve fibres in the arm have been stretched and damaged resulting in scar tissue within the healing nerves. The scar tissue can put pressure on surrounding healthy nerves, which can continue to impair the arm’s motor and sensory functions even if the injured nerves have healed. During the surgery the scar tissue is removed and a nerve from another part of the body is grafting on to repair the nerve ruptures.
Surgery will be required when nerves are torn. This usually involves splicing a nerve taken from another part of the baby’s body and grafting it to the damaged area.
If the nerve is completely torn from the spinal cord then it cannot be reattached. However, surgery may go ahead if the doctors are confident that some arm function can be restored by grafting a nerve from another part of the body.
If the nerve injury is less serious, physical therapy will be used to rehabilitate the movement and senses in the arm. This will have to take place with physiotherapy professionals and daily at home with parents or guardians. This can include gentle massage, and motion exercises to strengthen the arm and improve flexibility. Electrical stimulation of the nerves may also help recovery. If improvements are not seen within the short term then surgery can still be recommended.
What is the long term impact of Erbs palsy?
The long term impact of Erb’s palsy depends on the severity of the injuries to the nerves. Between 70% and 80% of cases will clear up within a 12-month period if the baby receives good and regular physical therapy treatment. The quicker rehabilitation treatment starts the better the recover can be.
Although rare, some children will suffer lifelong complications due to Erb’s palsy. This can take the form of a permanent loss of movement and sensation in the injured arm, which can make it difficult to perform everyday tasks. As the child gets older there is also the physiological impact of Erb’s palsy. The condition can make it hard to take part in sport and other activities, which can lead to low self-esteem, difficulty socialising and sometimes bullying. It may be necessary for the child to get help through counselling.
How much compensation can you expect for Erb’s palsy?
The amount of compensation provided to a victim of Erb’s palsy can vary greatly. It will depend on many factors, such as the severity of the physical injuries (e.g. paralysis), psychological and emotional trauma and anxiety, medical expenses incurred, pain and practical impact on the person’s social and financial life, and future care needs.
Depending on the individual’s circumstances some patients will claim compensation for thousands of pounds, while a more severely affected Erb’s palsy patient with severe paralysis could require compensation that can amount to millions of pounds.