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Brachial Plexus Injury from Lateral Traction

Our lawyers handle brachial plexus birth injury malpractice lawsuits.  

The brachial plexus is a network of nerves that transmits signals from the spine to the shoulder, arm, and hand. Brachial plexus injuries birth injuries cause damages - sometimes, but not always permanent - damage to those nerves.

These are tough injuries.  Half of brachial plexus injuries result in complete paralysis of the arm.  Other children who suffer this injury during childbirth struggle with poor movement, sensation loss and unremitting pain in their arm.

The vast majority of brachial plexus injuries our law firm sees are from childbirth.  Our lawyers occasionally see adult brachial plexus cases, too.  We see many seatbelt injuries where the lap belt crosses the brachial plexus.  Our law firm also sees motorcycle and four-wheeler brachial plexus injury crashes.  

Brachial plexus injuries during childbirth often occur from excessive lateral traction on the infant's head during birth. Excessive traction to free the shoulder pulls the child's delicate head and can cause injuries to nerve roots, commonly the C5, C6 and C7 nerve roots of the brachial plexus. 

Infants delivered with excessive traction can suffer rupture or avulsion injuries. These are the most troubling.  While our ability to repair brachial plexus injuries is improving, there is there little hope for a recovery from an avulsion or rupture without immediate surgery to reconnect the nerve network and the spine.

Is the cause of the brachial plexus injuries medical malpractice? According to the medical literature, most obstetric brachial plexus birth injuries are related to traction applied by OB/GYN or midwife during the birthing process.

birth injuryThe defenses in cases involving brachial plexus injuries from excessive traction are largely the same. First, the brachial plexus injury occurred in utero. Second, the doctor made only "gentle tugs" in the child's delivery. If that argument fails, the doctors either blame the mother ("natural expulsive forces") or claim that the lateral traction was necessary for delivery.

Certainly, these are sometimes valid defenses. Not every brachial plexus injury is medical negligence. But brachial plexus injuries are a leading cause of medical malpractice lawsuits for a reason: doctors often use excessive traction in a panic when the child's anterior shoulder initially became impacted on the pelvic bone. In many cases, the OB/GYN delivering the baby often uses excessive lateral traction, pulling on the head using the corkscrew maneuver rather than placing his hand inside the mother's vagina and onto the baby's shoulder and rotating.

It is hard for defense lawyers to defense an avulsion case.  The only way you can have an avulsion is to pull the nerve off the spinal cord. The only way you are going to pull the nerve completely off the spinal cord is if you pull the head and the shoulder away.  If the obstetrician does pull the head and shoulder away, you can expect this kind of injury.  

A little bit of traction is not going to cause an avulsion injury.  Pulling a nerve off the spinal cord requires a great deal of traction, usually by an OB who panicked at the first sign of a problem.  It requires a force that exceeds not only the strength of the ligaments that attach to the nerve, but also exceeds the tensile strength of the spinal cord itself.  So while the defense lawyers will also claim some other cause, it is nonsense in these kinds of cases. There is zero chance such an injury is caused by the "natural forces of labor" as the defense experts often claim.

  • What is the settlement value of a brachial plexus claim for the child and the parents?
  • Answers to your questions about brachial plexus injury claims

How to Spot Medical Malpractice

Brachial plexus injuries usually occur from mechanical force during delivery when the shoulder becomes wedged underneath the pelvic bone. When this happens, the doctor may see the baby's head come out and then retract (much like a turtle). This is a clear sign that something is stuck. At this point, it is incumbent upon the doctor to try and maneuver the baby to get it out. This takes time (usually 3 to 5 minutes). A clear indication of malpractice is if the doctor proceeded to deliver the baby in a relatively short period (30 seconds to 1 minute).

Another sign of medical malpractice is if the doctor used forceps or suction once the baby was stuck. The excessive force from the forceps or suction could damage the nerves. In their defense, the doctors may try to argue that the brachial plexus injury could occur in utero. However, brachial plexus injuries in utero rarely occur because there is not enough force to damage the nerves. In utero, there simply is nothing for the baby to be wedged against to cause that harm. Also, in utero infections can be ruled out by testing the baby once it is born.

Verdicts and Settlements

This is a sampling of brachial plexus palsy birth injury jury verdicts around the country in recent years:

birth injury
  • New Jersey, 2017: $900,000 (excessive traction failure to give c-section case causing shoulder dystocia)
  • New Jersey, 2017: $1,340,000 (another excessive traction case in New Jersey, this one causing left-sided Erb's palsy)
  • Florida, 2012: $780,000 (brachial plexus palsy to the left arm during childbirth)
  • Virginia, 2010: $2,230,000 (verdict against midwife for brachial plexus injuries suffered by the child during labor and delivery leading to a permanent right arm injury. Boy was required to undergo nerve transfer surgeries)
  • California, 2010: $932,250 (shoulder dystocia injury leading to brachial plexus paralysis/ doctor did not attempt McRoberts or Woods maneuver to dislodge the child's left shoulder. Child needed tendon transfer surgery when he was six months old.)
  • Texas, 2010: $1,799,600 (plaintiff claimed doctor pulled down too hard on child's head when while trying to free the shoulder and the nurses applied fundal pressure to the mother, which is exactly what they should not do during a potential shoulder dystocia)
  • New York, 2009: $ 60,939,847 (excessive traction to the child's head during delivery resulting in brachial plexus injury. The child also suffered lateral medullary syndrome, a condition that causes impairment of speech and the ability to swallow).
Getting Help from a Medical Malpractice Lawyer

If you believe that you or your child suffered a brachial plexus injury as the result of medical malpractice, call one of our caring malpractice lawyers today at 800-553-8082 or get a free online consultation.

Brachial Plexus Medical Literature 
  • Dy, C.J., et. al: A systematic review of outcomes reporting for brachial plexus reconstruction. J Hand Surg Am. 2015; 40: 308–13.  The study talks about how most of the literature talks about functionality and does not talk about the ongoing pain that can come with these injuries.
  • Hill B, et al. Letter regarding outcome reporting for brachial plexus reconstruction. J Hand Surg Am 2015;40:1504.   This letter provides commentary on Dr. Christopher Dy's article list above.
  • Volle, E., et. al: “Radicular avulsion resulting from spinal injury: assessment of diagnostic modalities,” Neuroradiology, vol. 34, no. 3, pp. 235–240, 1992.  Fractures came come with avulsion injuries from excessive traction. This article underscores the importance of doctors verifying that the baby did not suffer any birth trauma fractures. 
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