Our lawyers handle brachial plexus malpractice lawsuits. These birth injuries have declined in recent years. Why? Because brachial plexus birth injuries are on the decline.
But obstetricians still make too many mistakes in 2023, delivering babies with excessive force and causing lifelong injuries. This page looks at brachial plexus lawsuits and settlement compensation amounts you can expect in these sometimes tragic cases.
What Is the Brachial Plexus?
The brachial plexus is a network of nerves that transmits signals from the spine to the shoulder, arm, and hand. Brachial plexus birth injuries cause damage – sometimes, but not always permanently – to those nerves.
These injuries are hard on children when they do not resolve. Half of all 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 arms.
Brachial Plexus Lawsuits Our Lawyers See
Most brachial plexus injuries our law firm sees are from childbirth. Our lawyers occasionally see adult brachial plexus cases, too. Our lawyers 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 little hope for recovery from an avulsion or rupture without immediate surgery to reconnect the nerve network and the spine.
Brachial Plexus Injuries and Medical Negligence
Brachial plexus injuries are a leading cause of medical malpractice lawsuits, and there is a good reason. According to the medical literature, most obstetric brachial plexus birth injuries are related to excessive traction applied by an OB/GYN or midwife during the birthing process. Doctors often use excessive traction in a panic when the child’s anterior shoulder initially became impacted by the pelvic bone.
If your baby is born with a brachial plexus injury, you should always consider the possibility that the injury resulted from medical negligence during the delivery. This is particularly true if the doctor used forceps or a vacuum extractor during delivery.
Obstetric delivery instruments can frequently cause too much force and damage the baby’s nerves. Another telltale sign of malpractice is the severity of the nerve damage. The more severe the nerve damage, the more likely the doctor used excessive force.
The most severe type of brachial plexus nerve injury is called an avulsion. It is hard for defense lawyers to defend avulsion cases. The only way you can have an avulsion is to pull the nerve off the spinal cord.
This level of nerve injury doesn’t happen without significant force during delivery. 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.
Brachial Plexus Settlement Value
If your child has suffered a brachial plexus injury, you are looking for answers for your child. One answer may be getting compensation to help your child cope with this injury. If you want the best for your child, it is a very reasonable question to ask what the average settlement value of brachial plexus birth injury cases is and what your child’s claim might be worth.
The average settlement or verdict in brachial plexus birth injury cases in the ten example cases below is over $2 million. But these injuries vary wildly in severity. So the payout average is not a particularly useful number here.
Ultimately, the answer to the range of settlement amounts your family’s brachial plexus lawsuit lies in your child’s medical records. (Our lawyers will review these for you at no charge.)
Below we have provided sample claims to help you better understand the value range of these cases. If the case sounds just like yours, can you assume the settlement or trial compensation payout is exactly the same? Of course not. Still, these 17 cases are a big enough sample size of results and facts to help you better understand the potential value of your case.
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FAQs
What is the Brachial Plexus?
The brachial plexus is a network of nerves in our neck and shoulders. These nerves carry electrical signals from the brain and spine to the muscles in the shoulder, arm, and hand. An injury to the brachial plexus injury occurs when these nerves are compromised. These nerves send messages that allow movement and sensation to reach the arm. If the path of the nerve is compromised, the signals from the brain will not reach the individual muscles in the arm which will limit the normal use of the arm. If the damages are severe, there can be paralysis of an entire arm.
How Does the Brachial Plexus Get Injured During Childbirth?
Babies suffer brachial plexus injuries during childbirth when their head or shoulder remains stuck at the top of the birth canal and the doctor pulls too hard or uses excessive lateral traction. This can overstretch and/or tear the nerves in the brachial plexus. This type of brachial plexus injury is very common when complications such as shoulder dystocia arise.
How Much Are Brachial Plexus Injury Cases Worth?
The average settlement value for a birth injury malpractice case involving a brachial plexus injury is around $750,000 to $2,500,000. The reason for this very wide range is that birth injuries to the brachial plexus can vary significantly in terms of severity and permanency. Some brachial plexus injuries can leave a child with permanent arm paralysis, while in other cases the permanent impact is minimal.
How Common Are Brachial Plexus Injuries?
Brachial plexus injuries during childbirth occur in about 4 out of every 1000 live births in the U.S. Only 5% to 20% of these brachial plexus injuries result in permanent paralysis to the arm. Our brachial plexus palsy malpractice attorneys review a lot of these cases every year.
How Much Force Is Necessary to Cause a Brachial Plexus Injury?
Brachial plexus injuries during childbirth are almost always caused by the use of excessive lateral traction by the OB/GYN. The exact amount of force required to damage the brachial plexus is not clear, and probably varies depending on a number of factors. However, if a baby suffers severe damage to its brachial plexus during delivery, that alone is a good indication that the doctor may have used too much force.
But is not like “X amount of force = brachial plexus injury.” Determining the amount of force necessary to cause a brachial plexus injury can be difficult and will depend on a variety of factors. In some cases, a brachial plexus injury may be caused by a relatively minor impact, while in other cases, a significant amount of force may be necessary to cause damage to the nerves.
When Do You Know a Brachial Injury Is Permanent?
Healing of nerve damage may occur over two years although one study suggests that 93% of patients who reach full recovery will do so in four months. Still, with a newborn, it is hard to tell. The only way to know an injury is temporary is letting this time pass unless you conduct testing. An MRI will show nerve root avulsion.
Nerve resection surgery would also likely reveal the extent of the damage. But, more typically, the answer comes with time. Where the injury is permanent is relevant to causation. Resolving brachial plexus injuries are far less likely to be the result of a medical error. It makes sense, right? Natural force can lead to a small intrusion that resolves.
So while brachial plexus injuries can occur with negligence, a permanent brachial plexus injury will almost invariably not occur on an intrauterine basis with a healthy and anatomically normal fetus as a result of merely maternal expulsive forces.
A Good Test for Brachial Injury
A test called Electrodiagnosis (EDX) is used for injuries in the brachial plexus. EDX can help doctors figure out where exactly the injury is, how bad it is, and what caused it. This test is really handy because it can even find tiny defects in muscles that doctors might miss when they just look at the injury.
Doctors can also use EDX after surgery to see if the nerves are healing properly. During surgery, this test can tell surgeons if nerve signals are passing through injured areas, which helps them decide the next steps in treatment.
However, using this test can be tricky. Sometimes there can be multiple injuries, and the doctor has to check both the injured and the non-injured arm to compare them. The results of the test need to match with the type and seriousness of the injury.
So EDX is super useful when treating injuries in the brachial plexus. It’s the only test that can show how well the injured part is working, which is what both the patient and the doctor really care about. But the test needs to be done properly and at the right time.
What Causes Parents to Suspect a Problem?
In almost a hundred percent of brachial plexus cases, you will have a flaccid arm. This means the arm does not move and stays floppy.
Will a Brachial Plexus Injury Occur in Utero?
A brachial plexus injury is unlikely to occur in utero. Why? These are stretch injuries. This is the pulling apart of the muscles. An injury like this to an infant is going to happen during childbirth. You often even see a hematoma inside the muscle where the muscles have been pulled apart. You also cannot move the head sideways in utero because there is no type of pulling mechanism that can cause this kind of injury.
Although some defense lawyers and experts make this in utero brachial plexus injury argument at trial, no peer-reviewed studies suggest this is how these injuries occur. According to the literature, most obstetric brachial plexus injuries are related to traction applied by the clinician during childbirth.
How Often Is Shoulder Dystocia the Cause of a Brachial Plexus Injury?
Brachial plexus injuries do occur in the absence of shoulder dystocia and even in the absence of traction to the fetal head. But the medical literature is clear that “brachial plexus injuries remain the near-exclusive domain of shoulder dystocia-complicated births.”
In the history of medical literature, no treating obstetrician alone has ever documented a permanent injury without shoulder dystocia or traction to the head. The reason is mechanically uterine forces cannot stretch the fetal brachial plexus nerves to cause a permanent mechanical injury in a cephalic delivery.
Is Surgery to Repair Brachial Plexus Injury the Best Option?
Surgery for a brachial plexus injury has become more common with improved surgical techniques, such as micro neuro-surgical technique and nerve grafting. The decision for surgery with brachial plexus injuries in babies depends on several factors, including the severity and location of the injury, the baby’s age, and the potential for nerve regeneration.
If the injury is mild, surgery may not be necessary, and the baby may recover with physical therapy alone. However, surgery may be recommended if the injury is more severe and there is significant nerve damage or if there is evidence of muscle atrophy or contracture. The best example is when there is root avulsion. Surgery should be done in these cases as soon as possible because early muscle reinnervation correlates with better outcomes.
If surgery is generally recommended, surgical intervention within the first 3-6 months of life best optimizes nerve regeneration and muscle recovery. After some point, the muscles may become permanently weakened or atrophied, making it more difficult to recover full function.
Surgical Options for a Brachial Plexus Injury
Several surgical options for brachial plexus injuries in babies include nerve grafts, nerve transfers, and muscle transfers. The specific surgical approach will depend on the location and severity of the injury.
When deciding on the timing and type of surgical intervention, several factors need to be considered, such as the level and extent of the injury. In general, proximal muscle groups have a better prognosis for recovery than distal muscle groups, so attention on brachial plexus reconstruction has focused on proximal muscle groups and those groups that can provide the most useful upper extremity function. Restoration of elbow flexion is the priority in treating the injured plexus, followed by shoulder stabilization and, lastly, wrist and hand prehension (dexterity).
Recent Studies on Brachial Plexus Injuries
- Kaijomaa, M, et al: (2021). Impact of simulation training on managing shoulder dystocia and incidence of permanent brachial plexus birth injury: An observational study. BJOG: An International Journal of Obstetrics & Gynaecology. PMID: 36052568. doi: 10.1111/1471-0528.17278. This Finish study aimed to investigate the effect of a simulation training program on managing shoulder dystocia (SD) and the incidence of permanent brachial plexus birth injury (BPBI) at Helsinki University Women’s Hospital. So does being a better-trained doctor limit the number of brachial plexus injuries. The study analyzed the data from 2010 to 2019, dividing the period into pre- and post-training phases. The results showed that despite an increase in SD risk factors, the number of permanent BPBI cases decreased significantly after implementing the simulation training program. The most significant change in SD management was the increased incidence of successful delivery of the posterior arm.
- Dixit, N. N., et al. (2021). Preganglionic and postganglionic brachial plexus birth injury effects on shoulder muscle growth. The Journal of Hand Surgery, 46(2), 146-e1. This study looked at whether the preganglionic and postganglionic brachial birth plexus injuries had different effects on shoulder muscle growth. The researchers found that babies with postganglionic brachial plexus injuries experienced more restricted shoulder mobility. However, they also found that affected muscles in preganglionic experienced more severe alterations. The researchers concluded that the contracture presence also depended on post-injury muscle mass loss and restricted muscle growth.
- Grahn, P., et. al (2021). A protocol-based treatment plan to improve shoulder function in children with brachial plexus birth injury: a comparative study. Journal of Hand Surgery (European Volume). This study examined whether a protocol-based treatment plan improved shoulder function in children with brachial plexus birth injuries. The treatments included early passive exercises, botulinum toxin-A injections, ultrasound screening, shoulder splinting, and targeted surgeries. The researchers’ data showed that 48 percent of patients developed posterior shoulder subluxation. However, they also found that they could detect the condition at less than five months instead of at five years old. There was also less need for relocation surgery. The researchers concluded that their protocol could potentially reduce the chances of poste
prior shoulder subluxation in infants who suffered from brachial plexus injuries. - Manske, M. C., et al. (2021). Long-Term Outcomes of Biceps Rerouting for Flexible Supination Contractures in Children With Brachial Plexus Birth Injuries. The Journal of Hand Surgery. This study examined the long-term outcomes of children with brachial birth plexus injuries and forearm supinations who underwent bicep re-routings. The researchers concluded that the bicep re-routings improved forearm positioning without exacerbating elbow flexion contractures or decreasing shoulder mobility. The authors suggested that this procedure could preclude severe supination contractions and decrease the demand for forearm osteotomies.
- Morrow, et al. (2021). Long-Term Hand Function Outcomes of the Surgical Management of Complete Brachial Plexus Birth Injury. The Journal of Hand Surgery. This study investigated long-term hand function outcomes of children suffering from brachial plexus birth injuries that underwent a primary nerve reconstruction. The researchers found that over 80 percent of patients could adequately perform bimanual tasks at eight years old. They concluded that primary nerve reconstructions improved hand function in children with brachial plexus birth injuries.
- Nickel, K. J., et al. (2021). Nerve Transfer Is Superior to Nerve Grafting for Suprascapular Nerve Reconstruction in Obstetrical Brachial Plexus Birth Injury: A Meta-Analysis. HAND. This review examined whether nerve transfers were superior to nerve grafting in treating a brachial plexus birth injury. The researchers examined four studies on this subject. They found nerve transfers associated with greater shoulder rotation than nerve grafting. The researchers also found that nerve graft patients were more at risk of undergoing a secondary shoulder procedure. They concluded nerve transfers were associated with improved shoulder rotations and lower secondary shoulder procedure rates.
Talk to the Birth Injury Lawyers at Miller & Zois for a Free Case Evaluation
If your child has a brachial plexus injury and you are unsure if it was caused by medical negligence during childbirth, we can help. The birth injury lawyers at Miller & Zois can help investigate whether you have a viable medical malpractice lawsuit – and deliver results if you do. Call our Maryland birth injury malpractice lawyers at 800-553-8082 today or get a free online consultation.