14 October marks the beginning of Erb’s Palsy Awareness Week. Erb’s Palsy, also known as Brachial Plexus Paralysis, is a condition affecting any number of the 5 primary nerves that make up the brachial plexus, which supplies movement and feeling to the arms. It is vital to raise awareness of Erb’s Palsy as unfortunately, many people do not know about it or understand it until it happens to a loved one.

Erb’s Palsy often occurs due to trauma during childbirth, such as due to shoulder dystocia. Shoulder dystocia occurs when the baby’s head gets stuck behind the mother’s pelvic bone after the head has been delivered. It is an emergency and the shoulder needs to be released as quickly as possible so that the baby’s body can be delivered. This may involve trying to manually free the baby’s shoulder and there is a risk of this causing damage to the brachial plexus nerves.

Shoulder dystocia, although an emergency, is a recognised complication of childbirth and it can occur unexpectedly. However, there are some circumstances where it is more likely to occur, such as if you have had shoulder dystocia with a previous delivery, if you have diabetes, your BMI is 30 or more, you labour is induced, you have a long labour or you have an assisted vaginal birth. Shoulder dystocia is more likely with large babies and if a mother has diabetes, they will usually be offered early induction of labour or planned caesarean section due to the risk.

About 1 in 10 babies who have shoulder dystocia will have some stretching of the brachial plexus nerves. Erb’s Palsy can also occur without shoulder dystocia, including in babies born by caesarean section.

Common symptoms of Erb’s Palsy include:

• Loss of sensation in the arm
• Paralysis
• Being unable to raise the arm
• Being unable to flex the elbow.

The C5 and C6 nerves are the most commonly affected nerves; classic signs of these nerves being injured are an elbow which does not bend and the hand being held in a ‘waiters tip’ (turning backwards) position.

Every case of Erb’s Palsy is different in terms of how it affects the child. The severity of the injury depends on a number of factors, such as how many nerves are affected and how badly the nerve has been damaged. If all of the nerves are affected, this will affect the entire arm and hand and there may be an associated Horner’s syndrome, which is when the eyelid droops and the pupil in the eye may be smaller. The baby may also have an associated Torticollis, which is where the baby faces away from their affected arm and is unable to face forward for any length of time.

In respect of how badly the nerve has been damage, if the fibres have only been mildly stretched, they may return to normal and the child should recover use of the muscle. More severe injuries may result in scar tissue forming at the site of injury, which can stop the electrical signals that travel through nerves, or even in the nerve being completely pulled apart or torn away from the spinal column. More severe injuries may be helped by surgery to repair the nerve but there may still be remaining weakness in the arm.

If your child has suffered Erb’s Palsy and you believe it may have been negligently caused, you may be able to bring a claim for clinical negligence. A successful claim for clinical negligence will result in financial compensation, which although unable to change the injury suffered, can allow scope for private therapy and treatment to get the best possible outcome and level of mobility. Please contact our experienced Clinical Negligence Team on 01482 323697 to discuss how we can help.