Medical Malpractice
Erb’s palsy is a type of birth injury resulting from damage to the upper brachial plexus nerves in a baby’s upper arm and neck area. This traumatic process mostly involves C5-C6 and sometimes C7 of the brachial plexus, the network of nerves that runs from the spinal cord through the axilla to the arm. The brachial plexus nerves facilitate feeling and control movement through the arms down to the fingers. Babies with Erb’s palsy have some level of paralysis in their arm and hand due to damage to these nerves. Often, the baby will be unable to move the affected arm and shoulder but may have movement in the fingers and hands. The arm will be noticeably limp in a baby with Erb’s palsy.
Erb’s palsy can come with different levels of severity depending on what type of damage is done to the nerves. There are 4 types or levels of nerve damage that can result in some combination in cases of Erb’s palsy:
- Neurapraxia: the nerves are stretched/strained but not torn. Neurapraxia damage is the least severe and can usually heal on its own in a few months.
- Neuroma: this is more extensive stretching of the nerve(s) that actually damages the nerve fibers themselves. This type of damage won’t completely heal itself because when these damaged nerve fibers heal, scarred tissue forms that can cause permanent pinching of nearby healthy nerves.
- Ruptures: ruptures occur when the nerve fibers actually tear. A torn nerve may not heal adequately on its own, and this type of damage may require surgery to reconstruct the nerve fiber with grafted nerve tissue.
- Avulsions: this is the most severe type of nerve damage where the nerve fiber actually becomes detached from the spine. Once severed from the spine, it cannot simply be reattached.
What Is the Difference Between Shoulder Dystocia and Erb’s Palsy
Shoulder dystocia is when, after the delivery of the head, the anterior shoulder of the infant gets stuck, requiring the OB or midwife to make manipulations to deliver the child. Shoulder dystocia occurs in approximately 2% of births. Erb’s palsy is paralysis or weakness of the arm caused by injury to the upper brachial plexus. Shoulder dystocia is one of the obstetric complications most closely associated with Erb’s palsy, particularly when excessive lateral traction is applied to the baby’s head or neck while the shoulder is stuck. These conditions often travel together, but Erb’s palsy can also occur without recognized shoulder dystocia.
What Causes Erb’s Palsy?
As explained above, Erb’s palsy results from damage (4 different levels) to the upper brachial plexus nerves in the shoulder/neck area of a baby. The damage to the nerves can occur during labor and delivery, particularly during a difficult delivery. There are several different labor and delivery situations that can result in nerve damage and cause Erb’s palsy.
The obstetric complication that most often leads to Erb’s palsy is shoulder dystocia. Shoulder dystocia is a condition where the baby comes through the birth canal at an awkward angle and a shoulder becomes stuck on the mother’s pelvis. To overcome this complication, various maneuvers are employed, and excessive twisting and/or lateral force can damage the upper nerves, resulting in Erb’s palsy. Face presentation and breech delivery are similar situations where obstetric maneuvers used to facilitate delivery can result in Erb’s palsy.
Can Erb’s Palsy be Cured?
The long-term prognosis and treatment options for Erb’s palsy depend on how badly the baby’s nerves are damaged. If the nerve damage is limited, the Erb’s palsy will likely resolve on its own with minimal treatment. However, if the nerve damage is more severe the Erb’s palsy may result in some degree of permanent paralysis of the arm.
Does My Baby Have Erb’s Palsy
Although Erb’s palsy is an injury that occurs during childbirth, that does not mean you will know right away if your baby has the condition. Sometimes Erb’s palsy is evident right away, but in some cases, it may not be apparent until several days or weeks after delivery. The signs of Erb’s palsy eventually become easy to identify:
- Limp arm – may appear to be bent at the elbow
- Weakness or reduced movement in one arm
- Complete or partial paralysis of the arm
- Numbness in arm
Treatment for Erb’s palsy
Once Erb’s palsy is diagnosed, treatment typically begins with physical therapy. Physical therapy usually involves targeted massage and movement techniques. Sometimes the physical therapy will be augmented with Botox injections and/or electrotherapy.
If physical therapy fails to resolve the condition, several surgical treatment options are available. Ruptured nerve fibers cannot simply be stitched back together, so surgical treatment may involve reconstructing the damaged nerve. This means nerve tissue is grafted from somewhere else in the baby’s body and surgically implanted. This implanted nerve tissue serves as a framework for new nerve tissue to grow around.
How Long Does Erb’s Palsy Take to Heal?
The answer depends on the severity of the brachial plexus injury. Babies with mild stretching injuries may begin to regain movement within weeks or months and can sometimes recover with physical therapy alone. More serious injuries involving nerve rupture or avulsion may result in permanent weakness or paralysis and can require nerve surgery.
One thing parents and doctors watch closely is whether the baby begins regaining meaningful movement in the affected arm during the first several months of life. A lack of meaningful improvement can be a sign that the nerve injury is more severe and that additional treatment may be necessary.
Malpractice Claims for Erb’s Palsy
Some Erb’s palsy injuries are the result of preventable medical errors during delivery – excessive force, lack of skill, improper delivery technique, and poor communication by the delivery team. You have to be careful when looking at the records. OBs often describe the traction as “gentle” no matter how much force was used.
Not every case of Erb’s palsy proves malpractice. But when negligent delivery causes a permanent brachial plexus injury, the child may have a medical malpractice claim for the resulting damages. Below is a summary of some recent malpractice settlements and verdicts for Erb’s palsy:
- Anonymous v. Anonymous (2026): In a North Carolina case, a 6-year-old boy suffered a permanent brachial plexus injury during birth at WakeMed Raleigh Campus Hospital. All five nerves in his left brachial plexus were avulsed from the spinal cord, leaving him with permanent impairment of his shoulder, arm, and hand. His family alleged that the hospital and resident physician negligently managed the delivery and failed to use appropriate maneuvers. After a five-week trial in Wake County, the jury awarded $18.2 million, including $2.2 million in economic damages and $16 million in noneconomic damages.
- Anonymous v. Anonymous (2026): In a Georgia case, a newborn boy suffered a severe brachial plexus injury during a delivery complicated by shoulder dystocia. Four of the five brachial plexus nerves were torn from the spinal cord, leaving him with little use of his left arm and no meaningful use of his left hand or fingers. The plaintiff alleged that the obstetrician failed to offer a C-section despite risk factors for shoulder dystocia. A Fulton County jury awarded $6.25 million.
- Anonymous v. Anonymous (2024): In a Virginia case, a newborn suffered shoulder dystocia during a vaginal delivery and developed Erb’s palsy from a permanent brachial plexus injury. The plaintiffs alleged that excessive downward traction and additional pressure were applied during the delivery. The defense argued that the physicians did not use excessive force. The case settled shortly before trial for $1 million.
- Anonymous v. Anonymous (2021): A newborn girl suffered a permanent brachial plexus injury involving the C5 through T1 nerves, including an avulsion at C7, during a shoulder dystocia delivery. The plaintiff alleged that the OB/GYN improperly applied lateral traction to the baby’s head while the shoulder remained lodged behind the mother’s pubic bone. The child was left with limited range of motion and function in the injured arm. Her life care plan projected approximately $734,000 in future expenses. The case settled for $1.05 million.
- S.G., Pro Ami v. Garden City Obstetrics and Gynecology, P.C. (2020): A newborn girl suffered nerve root avulsion. She sustained right Erb’s palsy and Klumpke’s palsy. The girl was left with cosmetic deformities and emotional distress. Her mother alleged negligence against the OB/GYN practice. She claimed its staff improperly performed a vacuum-assisted vaginal delivery, used excessive traction, failed to address shoulder dystocia, and failed to perform a C-section. This case settled for $3.04 million.
- Cudney v. United States (2020): A newborn boy suffered right Erb’s palsy at a federally funded hospital. He underwent multiple procedures. The boy was left with limited right arm use. His mother alleged negligence against the federal government. They claimed the hospital staff failed to properly address shoulder dystocia, address macrosomia, and perform a C-section. The mother received a $956,504 verdict.
- A.H., Pro Ami v. Montefiore Medical Center (2020): A newborn girl suffered a brachial plexus injury. She sustained Erb’s palsy. The girl underwent a capsular release and tendon transfer. Her mother alleged negligence against the hospital. She claimed its staff improperly performed the delivery. This case settled for $1.13 million.
- D.C., Pro Ami v. Lipari (2020): A newborn girl sustained a left brachial plexus injury. She developed Erb’s palsy. The girl’s father alleged negligence against the physician. He claimed he improperly performed the delivery. This case settled for $365,000.
- Plaintiff v Erhart (2019): New York case involving a baby boy who suffered injury to his brachial plexus nerves during childbirth and was diagnosed with Erb’s Palsy and developmental delays. Defendant doctors were allegedly negligent in failing to diagnose fetal macrosomia in advance of delivery, which would have prompted a preemptive C-section. Had defendants properly diagnosed macrosomia and delivered via C-section his injuries would not have occurred. Case settled for $850,000.
- Garcia v. Endres (2017): A child suffered paralysis in his arm after it became stuck in the birth canal. The plaintiffs alleged the obstetrician pulled with too much force when trying to dislodge the baby’s shoulder, tearing the brachial nerves in his arm. The case settled for $1.2 million, most of which was put in a special needs trust so that child can use that money for care for the rest of his life.
- McAllister v. Women & Babies Hosp. of Lancaster (2017): In this Pennsylvania case, the baby was delivered with a fractured arm and nerve damage resulting in Erb’s palsy. The doctor was allegedly negligent in using forceps and excessive force in response to shoulder dystocia during delivery. Malpractice claims were settled for $1,000,000.
- Gurzakovic v. Bellevue (2017): New York case involving a baby girl who suffered severe brain damage and Erb’s palsy. The claim was failure to obtain informed consent concerning vaginal delivery, lack of Cesarean section, labor induction, and shoulder dystocia maneuvers. If the sole issue is informed consent, not negligence, the hill is high for the plaintiffs. This claim settled for an incredibly meager $50,000.
- Bussey v. Mother Bachman Maternity Center (2017): another Pennsylvania case alleging excessive force and torsion used during delivery caused Erb’s palsy. The case was settled for $325,000.
- L.J v. Lexington Health Services District (2017): a newborn girl suffered shoulder dystocia/disfigurement to her right shoulder, arm and hand after a vaginal delivery. The lawsuit alleged the doctors negligently failed to see the signs of shoulder dystocia and then used excessive force and traction during delivery. The case settled for only $450,000.
Obviously, you cannot use these verdicts to predict the value of your case. But they do give you some idea of the settlement value of these claims. In Maryland, noneconomic damages in medical malpractice cases are subject to a statutory cap that changes over time. So the key to the value of a serious Erb’s palsy case in Maryland is often how much money there is in past and future economic loss.
Defenses to Erb’s Palsy Cases
Not many reasonable people disagree that repeated traction and rotational force can cause Erb’s palsy. Still, there is not an Erb’s palsy birth injury case where the defense attorneys roll over and play dead. Insurance companies and hospitals will fight virtually every one of these claims, no matter how obvious the negligence may be. Defense lawyers argue that there is no evidence that the occurrence of Erb’s palsy alone is an indication of a deviation from the standard of care. They will tell the jury that the occurrence of Erb’s palsy does not necessarily indicate that excessive force was used by the delivering physician.
There are three common defenses to Erb’s palsy cases.
- Shoulder dystocia is not reliably predictive. Erb’s palsy can occur in the absence of recognized shoulder dystocia. Defense lawyers point to some studies that suggest that some cases of brachial plexus palsy involve deliveries where shoulder dystocia was not recognized. In support of this argument, they further contend that the incidence of Erb’s palsy has decreased very little despite a dramatic increase in the number of cesarean deliveries.
- Brachial plexus palsy can also occur in the posterior arm of infants whose anterior arm was impacted behind the symphysis pubis. Defense lawyers and their experts argue this as evidence that the injury can occur in the absence of negligence and instead as the result of maternal labor forces. The defense to these cases often involves trying to find some way to indirectly blame the mother, and this argument typifies this strategy.
- Malpractice defense attorneys argue that studies do not show a statistical relationship between brachial plexus palsy, the experience of the obstetric provider, or the number and type of maneuvers used to alleviate shoulder dystocia.
There are serious flaws in using these arguments to explain every brachial plexus injury. One huge problem is that these studies may define whether there was excessive lateral traction by whether the doctor admits there was excessive traction. One defense expert goes as far as to say if the doctor says “I didn’t exert excessive lateral traction on the fetal head,” then there must be another cause for the Erb’s palsy. Incredibly, he testified that the only exception to this rule would be if the baby was decapitated. Let the insanity of that sink in for a second.
In recent years, defense lawyers have pushed this idea that the “natural forces of labor” are what causes the baby’s injuries. As proof, they argue that many children are injured without documented excessive traction. The problem is that this theory often depends on obstetricians documenting excessive traction and pulling on the baby’s head. So the fact that doctors do not confess to malpractice in the medical records is used in these studies to say, “Look at all of these injuries without excessive traction.” That does not prove that excessive traction was used in every case. But it also does not prove the opposite.
In spite of what defense lawyers pretend, when there is a serious injury, these cases usually settle before a trial. It is hard to dispute that the application of excessive lateral traction on the fetal head and neck during delivery can cause these injuries. But victims need a birth injury lawyer who can make the appropriate arguments and find the right experts to support the claim.
Contact Miller & Zois About Erb’s Palsy Malpractice
If you or someone you know has a child with Erb’s palsy and believe you may be entitled to compensation, call us at 1.800.553.8082 or submit a request for a free consultation.