Dejerine-Klumpke palsy (also known as Klumpke's Palsy or Klumpke's paralysis) is the paralysis of the upper brachial plexus.
First, let's get some of the lingo straight even though even the medical experts in these cases often confuse them. Paralysis of the lower brachial plexus is known as Erb-Duchenne palsy. Klumpke's palsy usually coincides with Erb's palsy and is referred to as global brachial plexus palsy. The brachial plexus is a network of nerves which allows the transfer of signals from the spine to the shoulder, arm, and hand. Damage to those nerves result in brachial plexus injuries.
Medical experts disagree on the extent to which Klumpke's palsy is preventable. Some doctors say that Klumpke's palsy is usually preventable. Other doctors disagree. But no one can serious argue that Klumpke's palsy cannot be caused by medical malpractice. In too many tragic cases, a plexus injury causes lifelong injuries to children because of a simple mistake made by a doctor at the time of your life when you need the best possible medical care.What Causes a Brachial Plexus Injury
What happens when these injuries are caused by a medical mistake? Often what happens is there is a problem getting the baby to deliver. Some doctors simply panic before good medical practice says they should, and they apply excessive traction to get the baby out. There are lots of different things doctors attentive doctors who are on top of the problem should try first.
The reality is that in the vast majority of these excessive traction cases, the child could have been successively delivered using mild traction or other less drastic measures. Admittedly, it is a fine line to walk for these doctors - excessive traction is called for if there is an imminent risk of asphyxia injury. But these doctors are paid a lot of money to make the right call and no panic at the first sign of a problem.
There is also no question that when it comes to who panics most quickly in these situations, it is physicians who do not have a lot of experience delivering children.Types of Brachial Plexus Injuries
There are four types of brachial plexus injuries:
The most severe avulsion, which occurs when the nerve is torn from the spine. Rupture and refers to a torn nerve, but not at the spinal attachment. Neuroma occurs when the scar tissue from healed torn nerve exerts pressure on the injured nerve preventing it from transferring signals to the muscles. Neurotropic is the most common injury, is a nerve that has been damaged but not torn, it is also referred to as "stretch."Causes of Brachial Plexus Injuries
Brachial plexus injuries may occur from injuries sustained during difficult childbirth or from other trauma. During difficult childbirths, a baby's shoulders may become impacted (shoulder dystocia) and the brachial plexus nerves stretch or tear, especially if the physician pulls on the baby's head. Though obstetric brachial plexus injuries usually occur from vaginal childbirth, injuries can also occur during Cesarean section. It is estimated that the prevalence of brachial plexus palsy is three in every one thousand births. In older children, adolescents and adults, injuries can occur from sports injuries, gunshot wounds, animal bites, viruses, high-velocity accidents such as motorcycle or ATV accidents or poorly positioned arms during medical procedures. In cases of injury during childbirth, attending physicians may be aware of complications but may or may not document them or steps taken to resolve this issue. This often makes it difficult to determine the particular cause or liable party of the injury in newborns.Risk Factors for Klumpke's palsy
Risk factors for Klumpke's palsy include:
- Macrosomia (a large baby)
- Pelvic size or shape (e.g. a small pelvis)
- Excessive weight gain by the mother
- Gestational diabetes
- Short maternal stature
- A shoulder dystocia or a brachial plexus injury at a prior birth
- Slow dilation/descent
- Use of forceps or vacuum extractor as an aid in childbirth
Symptoms of brachial plexus injury include lack of muscle control, lack of feeling or sensation or paralysis of the arm, hand or wrist. Electromyography may be used to diagnose brachial plexus injuries. In a study reported in the American Journal of Obstetrics and Gynecology, researchers reviewed children suffering brachial plexus palsy after vaginal delivery at John Hopkins between 1993 to 2004 and data representing litigated permanent brachial plexus palsy reported between 1986 and 2003 was reviewed from multiple institutions. The study reported that non-shoulder dystocia brachial plexus palsy is rare and distinct from shoulder dystocia brachial plexus palsy and can be distinguished by risk factors including birth weight, posterior arm involvement, injury severity, and fetal acidosis.Treatment and Outcome
Thankfully, brachial injuries will sometime heal on their own. Others may require occupational or physiotherapy, electrostimulation, botox injections, water therapy or surgery to correct the damage. Prognosis is dependent on the injured site and type of brachial plexus injury. Children generally recover within 3 to 4 months of the injury caused during childbirth however some may suffer long-term complications.
Then there are chronic complications. They can include an inability to supply nerves to the affected area, decreased strength and stamina, altered movements and biomechanics, muscle atrophy, impaired bone growth, joint dysfunction, osteoarthritis, difference in limb length, scapular winging, glenohumeral dysplasia, scoliosis, balance and coordination problems, decreased dexterity, psychological problems, partial paralysis of the diaphragm and Horner's Syndrome (drooping eyelid).Getting a Lawyer to Figure Out Your Child's Claim
Brachial plexus injury is a leading cause of serious injury doctor error lawsuits. If you believe that you or your child has been injured by a mistake of a doctor in Maryland, call us at 800-553-8082 or click here for a free online, no obligation consultation.