What Is a Brachial Plexus Injury?

A brachial plexus injury is one of the most well-known birth injuries associated with difficult deliveries. The brachial plexus is a network of nerves that extends from the spinal cord through the neck and into the shoulder, arm, and hand. These nerves control movement and sensation throughout the upper extremity. When they are stretched, compressed, or torn during childbirth, a newborn may experience weakness, limited movement, or even permanent paralysis of the affected arm.

Although some brachial plexus injuries resolve with time and therapy, others require surgery and may leave a child with lifelong physical limitations. In many cases, these injuries are preventable when healthcare providers recognize delivery complications early and make appropriate decisions about how to safely deliver the baby. At Kalfayan Merjanian, LLP, we represent families whose children have suffered preventable birth injuries and work with leading medical experts to determine whether negligent obstetrical care and medical malpractice contributed to the injury.

What Is the Brachial Plexus?

The brachial plexus is a complex group of nerves that originates in the neck and travels into the shoulder, arm, and hand. These nerves allow a person to lift, bend, rotate, and use the arm while also providing sensation throughout the upper extremity. Because the nerves control so many important functions, damage to the brachial plexus can significantly affect a child’s ability to use the affected arm. The severity of the injury depends on whether the nerves were stretched, partially torn, or completely torn away from the spinal cord.

How Do Brachial Plexus Injuries Occur During Childbirth?

Most birth-related brachial plexus injuries occur when excessive force is applied to the baby’s head, neck, or shoulders during delivery. One of the most common scenarios involves shoulder dystocia, an obstetrical emergency in which the baby’s shoulder becomes lodged behind the mother’s pelvic bone after the head has been delivered. When shoulder dystocia occurs, healthcare providers must use carefully recognized obstetrical maneuvers to relieve the obstruction safely. Excessive traction on the baby’s head or neck can stretch or tear the brachial plexus nerves, leading to permanent injury. Brachial plexus injuries may also occur during other complicated deliveries involving difficult fetal positioning, unusually large babies, prolonged labor, or improper use of delivery instruments.

What Is the Difference Between a Brachial Plexus Injury and Erb’s Palsy?

The terms are often used interchangeably, but they are not the same. A brachial plexus injury refers broadly to any injury affecting the network of nerves that controls the shoulder, arm, and hand. Erb’s palsy is one specific type of brachial plexus injury involving damage to the upper portion of the nerve network, typically affecting shoulder movement and elbow flexion. Another, less common form is Klumpke’s palsy, which involves injury to the lower portion of the brachial plexus and primarily affects the hand and forearm. Because brachial plexus injuries vary in location and severity, each child requires an individualized medical evaluation.

What Symptoms May Be Present?

The signs of a brachial plexus injury often become apparent shortly after birth. Common symptoms include:

• Weakness in one arm
• Limited arm or shoulder movement
• An arm that hangs limp at the baby’s side
• Reduced grip strength
• Absent or diminished reflexes on the affected side
• Difficulty lifting or rotating the arm

The severity of these symptoms depends on the extent of the nerve damage. Some infants recover movement within several months, while others continue to experience permanent functional limitations.

Can a Brachial Plexus Injury Heal?

It depends on the nature of the injury. When the nerves are stretched but not torn, many infants experience significant improvement through physical therapy and careful monitoring. More severe injuries involving partial or complete nerve tears may require microsurgical nerve repair, nerve grafting, or nerve transfer procedures. Even with surgery, complete recovery is not always possible. Children with permanent nerve damage may require years of therapy, orthopedic treatment, and additional surgical procedures as they grow.

When Can a Brachial Plexus Injury Be Prevented?

Not every brachial plexus injury results from medical negligence. However, many are preventable when healthcare providers appropriately recognize risk factors, carefully monitor labor, and respond promptly to delivery complications. Potential warning signs that require careful clinical judgment may include:

• Shoulder dystocia
• Suspected fetal macrosomia (a larger-than-average baby)
• Prolonged labor
• Maternal diabetes
• Abnormal fetal positioning
• Failure of labor to progress

In some situations, a planned or emergency cesarean section may reduce the risk of traumatic injury when a vaginal delivery presents significant risks.

When Does a Brachial Plexus Injury Become Medical Malpractice?

A brachial plexus injury does not automatically mean that malpractice occurred. Medical negligence exists when healthcare providers fail to meet the accepted standard of care during labor or delivery. Examples of negligence or malpractice causing a brachial plexus injury may include:

• Applying excessive traction to the baby’s head or neck
• Improperly managing shoulder dystocia
• Failing to recognize risk factors before delivery
• Improper use of forceps or a vacuum extractor
• Delaying a medically necessary cesarean section
• Continuing a difficult vaginal delivery when safer alternatives exist

Whether negligence occurred depends on the specific medical circumstances and usually requires review by qualified obstetrical experts.

How Do Medical Experts Evaluate These Cases?

Birth injury litigation almost always depends on expert medical testimony. Obstetricians review prenatal records, labor and delivery records, fetal monitoring strips, nursing documentation, operative reports, and delivery notes to determine whether the healthcare team complied with the applicable standard of care. Pediatric neurologists, pediatric orthopedic surgeons, and other specialists evaluate the nature and severity of the nerve injury, while life care planners and economists may estimate the child’s future medical and financial needs if permanent disability exists. This expert analysis helps determine both whether malpractice occurred and the extent of the damages resulting from the injury.

What Kinds of Compensation Are Available for a Brachial Plexus Birth Injury?

If negligent medical care caused a preventable brachial plexus injury, a medical malpractice claim may seek compensation for the child’s current and future needs. Depending on the circumstances, damages may include, for example:

• Past and future medical expenses
• Physical and occupational therapy
• Surgical treatment
• Rehabilitation services
• Assistive devices
• Educational support
• Future lost earning capacity
• Pain and suffering
• Other damages available under California law

For children with permanent impairments, accurately projecting future medical care and related expenses is often one of the most important aspects of the case.

Contact Kalfayan Merjanian, LLP

A brachial plexus injury can affect a child’s strength, mobility, and quality of life for years to come. If your child suffered a nerve injury during childbirth and you believe medical negligence may have played a role, it is important to have the circumstances reviewed by experienced legal counsel and qualified medical experts. Kalfayan Merjanian, LLP represents families throughout California in complex birth injury and medical malpractice cases and is committed to helping parents pursue the resources their children need for long-term care and recovery. Contact Kalfayan Merjanian, LLP today to discuss your family’s legal options.