Anatomy Review: The Brachial Blexus

In a refreshing change from all the lawyer blogs that talk about Brachial Plexus (this one included), I found a blog that explains a lot about the functional anatomy of the Brachial Plexus nerve bundle.

It is a list with a description of each of the nerves involved.

The components of the Brachial Plexus is a topic that is always important to review, as it is so significant to everyday clinical practice.  Here is a brief overview of the divisions and actions of each component.

Enjoy.  Just go directly to this link and read through it if you are so inclined to dive this deep into the inner workings of the Bracial Plexus.  Functional Anatomy Blog

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New Software Predicts Risk of Birth Injury

Shoulder dystocia refers to a medical complication that occurs when the baby’s shoulder becomes stuck behind the mother’s pubic bone during delivery. When not handled properly, shoulder dystocia can result in serious injuries such as brachial plexus palsy, bone fractures and lacerations, among other things.

While there are a number of risk factors for shoulder dystocia (e.g. maternal diabetes, large birth weight baby, small pelvic bones), the complication can and often does occur without warning. However, a Canadian doctor had developed software that can predict the probability of this complication in women who have reached 37 weeks of pregnancy.

Called the CALM Shoulder Screen, the software system considers such factors as the mother’s height and weight to calculate the risk of shoulder dystocia. Though relatively new, CALM is already being used by obstetricians across the country.

If you’re concerned about your pregnancy, you may want to consider asking your doctor about the risk of complications during delivery and what emergency plans are in place to handle any problems that arise. Some, though not all, birth injuries are preventable with proper planning and care.


 

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Will Your Child's Brachial Plexus Injury Benefit from Surgery?

Not necessarily — a recent review of medical literature suggests that some infants born with an obstetrical brachial plexus injury (OBPI) fall in a “gray zone,” where it’s not clear whether surgery is beneficial. According to the researchers, approximately half of children they evaluated who fell within this gray zone fully recovered without surgery.
 

The study authors developed guidelines for surgical intervention for children in the so-called gray zone. “The guideline presented in this paper provides another framework for decision-making that includes other areas in addition to biceps recovery or elbow function,” the researchers concluded.
 

In particular, the guidelines take into consideration shoulder abduction and wrist extension scores based on the Active Movement Scale.
 

The study is published in the current issue of the Journal of Neurosurgery: Pediatrics and was conducted researchers at the McMaster Children’s Hospital in Ontario, Canada.


 

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What is Erbs Palsy?

It’s a term you may have heard, but what exactly is Erbs palsy?  Put simply, it is a birth injury that causes damage to an infant’s brachial plexus, the group of nerves that influence the fingers, hands and arms.  It affects one in every 1,000 to 2,000 babies, and given the number of babies born every day in the U.S. alone, those odds are disturbing to say the least.  But perhaps even more upsetting is the fact that this condition is often caused by medical negligence.

Erbs palsy develops as a result of trauma during birth.  Some of the most common causes of the condition include:

  • Prolonged labor
  • Size of the baby
  • Labor inducing medication
  • Breech birth (buttocks first)
  • Delivery using vacuum or forceps

Another common scenario that results in Erbs palsy is when an infant gets wedged in the birth canal during the delivery.  If a doctor pulls or applies too much force when attempting to extract the baby, it can cause the brachial plexus nerves to stretch or tear, resulting in irreversible damage.  It is from these types of situations that many birth injury negligence cases develop.

A lucky few babies who suffer from Erbs palsy at birth will eventually recover to lead normal lives; however most will not be so lucky.  The condition can manifest itself with symptoms such as:

  • Decrease in mobility of the limbs
  • Decrease of sensation in the limbs
  • Complete elimination of sensation and/or mobility of the limbs
  • Limb asymmetry
  • Paralysis


The severity of the condition can differ greatly in each birth injury victim, and any or all of these symptoms may be present.  In many cases, they will also be permanent.

Erbs palsy can forever alter the lives of the children it affects as well as the families left to care for them.  If your child suffered a birth injury due to a doctor’s negligence, you have the right to seek compensation for your losses.  Contact a medical attorney today. 



 

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Informing Your Child's School of Brachial Plexus Injury

Does your child’s school have adequate information regarding his/her brachial plexus injury?  Do the teachers and administrators know which arm is affected, what activities your child should avoid and what activities he/she might need help with?

To help parents provide their child’s school with the information they need, the Brachial Plexus Palsy Foundation has created a form which parents can fill out and give to teachers, nurses, therapists and anyone else involved in the child’s daily life. 

Because each child’s injury is unique, the form has been created so that parents need only check what applies to their particular child. The information sheet also comes with a glossary of terms, which can help others to better understand brachial plexus palsy injuries.
  
Check out the form here.


 

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Gum Disease Can Put Your Unborn Baby at Risk for CP

The increased hormones during pregnancy cause about half of all pregnant women to develop a gum disease called “pregnancy gingivitis,” according to the American Academy of Periodontology. Studies show that severe gum disease (periodontal disease) increases a woman’s risk of preterm delivery, and premature birth is a risk factor for cerebral palsy and a host of other health problems.

Another Risk: Brachial Plexus Injuries


Additional research has linked gum disease in pregnant women to the onset of gestational diabetes, which can cause a condition known as macrosomia, or big baby syndrome. Babies with macrosomia are at risk for suffering brachial plexus injuries (including Erb’s palsy) during birth because of their large size.

Preventing Gum Disease


To prevent gum disease during pregnancy, women should be sure to:

* Brush and floss daily remove plaque build up
* Have professional cleanings at three month intervals a
* Rinse after a bout of morning sickness


Visit the AAP website at www.perio.org/consumer/pregnancy.htm for more information on gum disease and pregnancy.

 


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Mayo Clinic on Cutting Edge of Erb's Palsy Treatment

Thousands of babies are born each year with Erb’s palsy, typically as a result of damage during birth to the network of nerves known as the brachial plexus. About 10 percent of babies with Erb’s palsy require treatment, which may include surgery.

 

Surgical procedures for treating Erb’s palsy in infants and small children are highly specialized and extremely delicate, and parents may not know where to turn to get the best treatment for their child.

 

The Mayo Clinic in Minnesota is one of the leading research institutions and treatment centers in the United States for injuries of the brachial plexus such as Erb’s palsy. Surgeons there perform hundreds of specialized procedures each year, using cutting edge surgical techniques to repair nerve damage in babies and children with the condition.

 

Parents can visit the Mayo Clinic website to read patient stories, to schedule an appointment or to find out more about current clinical trials.


 

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"New" Erbs Palsy Surgery

"New" because it's a surgery that has been around for years but only recently has been used for children.  The surgery involves reconnecting broken nerves to healthy ones.  Now repair can be done on young people before the injuries get to a point of no possible repair. 

Ella Woodruff is a three-year old who suffered an injury that left her left arm paralyzed and broke a bone in her neck.  Today she is almost back to normal because of this  surgery that was done at St. Louis Children's Hospital.

Dr. Susan Mackinnon, chief of the division of plastic and reconstructive surgery at Washington University's School of Medicine, summed up the results: "Spectacular. That's the adjective I would use."

Because of Ella's response to the surgery, physicians are holding high hope that the procedure could be used on children as young as three months.  They think that Ella's great response is due to her age and that her developing body was able to cooperate better with the surgery.

Erb's Palsy is an injury to the brachial plexus, a cluster of nerves that connects the arm and hands to the brain.  The injury often occurs during childbirth when the baby's shoulder gets stuck in the birth canal and too  much force is used in trying to free the baby.  The severity of the nerve damage determines whether healing occurs naturally or whether surgery could be used.

The old surgical method involved grafting a healthy nerve from some area of the body to the damaged nerve.  Ella's physician Dr. Gregory Borschel, a pediatric plastic surgeon with Children's Hospital, has said that this method has downsides such as leaving a part of the body numb since it has no nerve connection.  The recovery is also much slower.
 

"We did something called a nerve transfer, often a better option in pediatrics," he said. "Think of it as a bypass."

During a six-hour microsurgery, he cut the crushed nerve that exchanged messages between Ella's hand, arm, shoulder and brain and reconnected it to a healthy, redundant nerve — one that didn't have much to do.
 

As for Ella's recovery, "It was almost like nothing had happened," Borschel said. "Based on how rapid her recovery has been … she will likely max out our measurement scale."
 

 

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Brachial Plexus Injury Awareness Week

The United Brachial Plexus Network, Inc. (UBPN) and its Awareness Committee have announced that the 9th annual Brachial Plexus Injury Awareness Week will be celebrated from October 19th through October 26th, 2008.  The goal of the week long activity is to increase general awareness regarding brachial plexus injuries: traumatic injuries that can result in full to partial paralysis of one or both arms.

The brachial plexus is an arrangement of nerve fibres, running from the spine proceeding through the neck, the axilla (armpit region) and into the arm.  Injury to these nerves can result in a paralysis of the arm called Erb's Palsy which is almost always caused during birth. 

The most common cause of Erb's Palsy is dystocia which is an abnormal or difficult childbirth or labor.  The nerve injury  happens when too much force is used in the delivery trying to free a baby that is stuck in the birth canal.   When the baby's shoulder gets stuck behind the mother's pubic bone it is called shoulder dystocia.  However, there are several maneuvers and techniques that can be safely used to free the baby's shoulder thus avoiding damage to the brachial plexus nerves.

If the delivery is not handled correctly, the resulting nerve damage may result in varying degrees of weakness or paralysis of the shoulder, arm and hand.  The amount of paralysis will depend on which nerves in the plexus( network ) are injured.  In some cases the resulting paralysis could be permanent and in others the weakness or paralysis may be minor enough to resolve itself over time. 

This is where we see malpractice cases arise. It is often when communication in the delivery room breaks down, warning signs are missed or people aren't familiar enough with the maneuvers.
 

 

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Girl Claims 300,000 Pounds in Damages

A four-year old Gloucester, England girl - disabled from injuries at birth - is at the center of a 300,000 pound High Court claim for hospital negligence.  300,000 pounds translates to about $590,000 in U.S. dollars in today's money market(7/14/08).  Her mother, Olubunmi Alaka, is suing Lewisham Hospital NHS Trust.

The filed writ claims that Temiloluwa Alaka has a disabled shoulder as a result of injuries that occurred when she became stuck during delivery.  The nerves in her neck and shoulder were alleged to have been damaged.  She suffers permanent physical disability.  Physiotherapy has helped to some degree but but further improvement will not take place.  Her condition may7 deteriorate and surgery will not help her condition.

During delivery the baby's head was delivered but the shoulders became stuck and a midwife called for help.  Hospital staff noticed that the baby was not moving her left arm,questioned the possibility of Erb's Palsy but no structured follow-up was arranged.

Her legal team is claiming that the hospital had no logical, structured plan for dealing with shoulder dystocia, failed to implement guidelines, failed to supervise the midwife, allowed her to take overall responsibility for Mrs. Alaka's care and she pulled too hard when the baby got stuck.

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22 Million in Birth Malpractice

Heather Grow's daughter, Cassie, was delivered by caesarian section but only after she had been stuck in the birth canal for over thirteen hours.  In 1997 Heather was told that she had a narrow pelvic arch and that became an issue about two weeks before delivery when her doctors realized that the baby was about nine pounds.

Cassie got stuck in the birth canal clearly being pushed through an opening where she couldn't fit.  Attorney Patrick P.J. Beirne described it as like trying to push a watermelon through an opening the size of an apple.   Not only was Cassie too big for the birth canal but medical workers continued to give Heather drugs to make the uterus contract.  She continued having contractions every couple minutes.  This continued for hours all the while squeezing the baby's head causing brain damage.

Attorney Mark Mueller said that the doctor had a responsibility to ensure that Heather had a safe delivery.

Cassie, now 11, is a spastic quadriplegic. That means she has limited use of her limbs.

She can walk short distances but needs a walker. She can see but because the part of her brain that processes vision was damaged, her brain can't properly interpret what her eyes see. She has problems using her hands, and she is mildly retarded, Mueller said.

"These are permanent injuries," Mueller said.

The vast majority of the settlement is for Cassie's future medical needs  and future loss of ability to perform ordinary activities.

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$2.5 Million Illinois Erb's Palsy Verdict

In Illinois a two million plus dollar award was given to a four year old by a Lake County jury.   His permanent disability was caused when the doctor pulled too hard on the baby's neck during delivery.  As a result the boy suffered severe nerve damage.    He has had two surgeries so far and several physical therapy sessions.   His mother says he may need yet another surgery later this year.

In addition to Dr. Thakar, the lawsuit also named Dr. Thakar's employer, Greenleaf Obstetrics and Gynecology Associates in Gurnee.

"The award will provide for the physical and occupational therapy the child needs for the remainder of his life," Attorney Joe Kolar said. "The jury verdict will help pay for any future surgeries he may need and compensate him for the pain and suffering he will experience for the rest of his life."

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Erb's Palsy Best Children's Hospitals

From the US News and world Report, we now have the best Children's Hospitals in America.  The top 4 were not really a surprise, they were in Philadelphia, Boston, Baltimore and Denver.

It's easier to just read the article at their website.

Here's the link:  USNews.com Tweet this

Shoulder Dystocia is an obstectrical emergency

This is an abstract discussing Shoulder Dystocia that I found on the NIH website.  I bolded the text below to make a point which is simple. 

That is exactly why we have medical professionals.  We want them to be "familiar with the maneuvers" ... and "be prepared to institute" them when they are needed.

This is where we see malpractice cases arise.  It is often when communication in the delivery room breaks down, warning signs are missed or people aren't familiar enough with the maneuvers.

Shoulder dystocia is one of the most dreaded complications of vaginal delivery encountered by the obstetrician. Although risk factors for shoulder dystocia exist, approximately 50% of cases do not demonstrate the classic predisposing signs. Obstetricians can help patients decrease their risk for fetal macrosomia by frequent attention to weight gain, nutrition, and exercise during pregnancy and by aggressive management of diabetes. All obstetricians must be familiar with the maneuvers used to effect delivery of impacted shoulders and must be prepared to institute these maneuvers immediately in a crisis situation.

(emphasis added)

Source:  NIH website

My previous Shoulder Dystocia and Erb's Palsy post
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Erb's Palsy and Shoulder Dystocia

If you're looking for resources...well I just found a bunch that you could spend several hours wading through and reading.

First here is an image from the page showing positioning during labor that can lead to a brachial plexus injury.  Image is from   http://www.shoulderdystociainfo.com/whatis.htm

erbs palsy and shoulder dystocia image

I'm going to dig around that website a bit more, but the information there looks really solid.  So again if you're looking for a place to start your erbs palsy or shoulder dystocia research go check it out.

Also here is a previous post we out out showing a video (medical illustration) of shoulder dystocia.

Shoulder Dystocia video Tweet this

Shoulder Dystocia Medical Illustration Video

Here is a link to a video medical illustration.  It is a video just like the ones you might see used during the course of a medical malpractice lawsuit or case.  It would be used to present a visual representation of what happened during the birth that might have caused a shoulder dystocia injury.  Often juries find these videos helpful in understanding what happened.

Below is a link to the video.

3D Medical Animation: Shoulder Dystocia Injury Tweet this