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Erbs Palsy Solicitors - UK Medical Negligence Compensation Claim


Erbs palsy is a relatively rare condition that affects much less than 1% of the new born infants in the UK each year and is often the result of medical negligence. It is caused by an injury to the brachial plexus system of nerves which emanate from the spinal cord and travel through the neck vertebrae, across the shoulder and chest, down the arm to the tips of the fingers. The injury usually occurs during traumatic birth when the child�s head is under significant and excessive strain and pressure during delivery. A claim for compensation for Erbs palsy by a medical negligence solicitor can be of substantial value dependant on the injury which ranges from mild to severe, from temporary to permanent and may involve complete long term, full or partial paralysis of the arm.

Medical Negligence Solicitors

If you or your child have suffered personal injury and you fear you may have been the victim of incompetence or negligence there is no time for delay. In order to know what options you have you should seek expert legal advice as soon as possible. Our medical negligence solicitors operate a service with no charge whereby you can meet us in person or chat over the telephone with one of our experts and obtain initial advice. If you subsequently decide to proceed no further then that is your right and you will not be charged for our solicitors initial advice.

Compensation Claims

Many cases of erbs palsy result in a solicitors claim for compensation for medical negligence against the hospital or healthcare practitioners involved in the birth. In almost every potential UK medical negligence case public funding commonly known as legal aid will be granted by the Legal Services Commission to a child with no financial contribution being necessary notwithstanding the parent's income or assets which are not considered during the assessment process for a child applicant. It should be noted that the Legal Aid Agency will insist that the solicitor acting on behalf of a legally aided child in a medical negligence claim is a an accredited specialist who is a member of the Solicitors Regulation Authority panel of clinical negligence experts. Medical negligence arises when a healthcare professional fails in their duty of care to the patient and reasonably foreseeable harm occurs as a direct result of that breach. Medical negligence is the failure of a health care practitioner to treat and care for a patient with a reasonable degree of skill and care. The standard of care is not absolute but is established by what is normal within the medical profession. Failed treatment is not necessarily negligent treatment merely because of its failure and will be exonerated if a substantial body of the medical profession would have carried out similar treatment notwithstanding that other more established treatment may have been more successful provided that such minority treatment was logical in all of the circumstances. Damages that can be awarded in these cases can be substantial and may include such elements as lifelong care, medical expenses and estimated future loss of potential income. Subject to a few statutory exceptions a solicitors medical negligence compensation claim must either have been settled by the payment of or agreement to pay compensation or proceedings must have been issued in a court of law by the eve of the 21st birthday failing which the opportunity to claim damages may have been lost forever.

Cause and Symptoms

Erbs palsy is an injury most often caused to a child during the birth process, the symptoms of which may be visible immediately after birth. There is a group of known factors that predispose the child to this condition. The injury is caused by damage to the group of nerves that branch out from the spinal cord in the area of the neck and then form a network that passes across the shoulder called the brachial plexus and then along the arms to the tips of the fingers. These nerves control movement of the arms, hands and fingers and permanent disruption can cause serious long term disability. The symptoms can include a limp or paralysed hand with lack of muscle control and reduced sensitivity or numbness in the arm, hand or wrist. A baby suffering from Erb's palsy usually holds the affected arm down at the side rather than flexed up against the body. In addition the startle reflex has limited effect on the affected arm which does not move as would be expected.

The word 'palsy' in plain English means, and is interchangeable with the word 'paralysis' which indicates a loss of movement of a part or parts of the body which is usually an indication of a restriction in full or in part in the ability to contract or release a muscle or a group of muscles. This restriction of movement is usually caused by damage or irritation to nerves or may be as a result of brain damage. Examples include Erb's palsy (damage to the brachial plexus network of nerves), cerebral palsy (irreversible brain damage) and Bells palsy (irritation of the nerves that control movement of the face). Damage to nerves can be caused as a result of direct physical force or may be indirect as a result of exposure to irritants or pollutants both before and after birth. Erbs palsy is frequently a birth injury caused by the use of excessive force often precipitated by a medical emergency such as shoulder dystocia during birth which is life threatening and demands an immediate solution. (In certain cases, where there may be an allegation of inadequate health care, it may be advisable to discuss this injury with a clinical negligence solicitor.) The group of muscles that are affected in this condition are the biceps, deltoid and other muscles that surround the shoulder joint and upper back. (There are other conditions that are often associated with Erbs palsy including Horners syndrome, Kulmpkes palsy and torticollis.)

Erbs palsy is often caused by the use of excessive force during delivery particularly when the child's shoulder has become lodged behind the mothers pelvis resulting in the over zealous use of force by the midwife or delivering doctor which results in a tearing of the muscle and nerves in the area of the shoulder and also not infrequently results in a fracture of the collar bone situated in the shoulder. Incidents of this type are described as shoulder dystocia and it is understandable how the subsequent injury to the child occurs in the heat of the moment in what is usually seen as a medical emergency. Most hospitals have a policy for dealing with shoulder dystocia and follow established protocols after calling the most senior staff available.

Erbs palsy is frequently caused by the use of excessive force or inappropriate traction on the infants head or neck during childbirth often resulting from a failure to deal with a position of risk that may have been encountered or become obvious in the earlier stages of birth or pregnancy. There are a number of risk factors that should dictate a caesarean section to preclude the risk of shoulder dystocia and included in this group are a large estimated birth weight, maternal diabetes, older mothers, short maternal stature, the mother’s narrow pelvis or a similar problem in a previous birth. In addition there are cases where there are other indicators during birth including a prolonged second stage, protracted descent, failure of descent of the head, an abnormal first stage or the need for mid-pelvic or assisted delivery or once shoulder dystocia has occurred there is inadequate management of the problem and a failure to follow well established protocols to facilitate a normal risk free birth. These protocols should resolve the problem and include :-

  • repositioning the mother
  • applying traction in a horizontal plane
  • applying pressure to the pubic area
  • manoeuvring and changing the baby's position
  • carrying out the McRobert's manoeuvre
  • emergency caesarean section
  • deep episiotomy cut
  • breaking the mother's pelvic bone
  • breaking the baby's clavicle bone on purpose

Diagnosis and Treatment

There is a group of diagnostic techniques including nerve conduction tests that may be used to establish the presence of Erbs palsy however the injury is often painfully obvious from a visual examination of the child. Once a child has been diagnosed as suffering from Erbs palsy it is necessary to consider treatment. Babies who suffer from this injury are often left untreated for a few days in the hope that the injury will heal naturally and that a full repair with total return of function will take place spontaneously. In the event of residual disability the condition is usually treated by the use of physiotherapy which is carried out so as to mimic the natural movements of the arm. Most recovery will take place within a few months of the start of treatment however about a quarter of all affected children will have permanent residual disability after the completion of the treatment regime.

In addition to physiotherapy there are surgical techniques that may help in more severe cases of Erbs palsy and this may include nerve grafts to assist torn or ruptured nerves, muscle transfer into the shoulder to give the arm more movement and tendon transfers to the wrist to assist the hand and fingers to recover some movement.

Obstetric erbs palsy is relatively rare in the UK occurring in about 1 in 1,800 births. This condition, which is a totally preventable birth injury, occurs more frequently than Downs syndrome, muscular dystrophy and spina bifida yet the general public are largely unaware of it. Many cases are associated with shoulder dystocia with risk factors including babies who are large for their gestational age, excessive lateral traction exerted on the head and neck during delivery, an arm extended overhead in breach presentation during delivery and excessive traction applied to the child’s shoulders during delivery. The most obvious symptoms include the child being unable to extend the arm or rotate the arm from the shoulder or to rotate the arm at the elbow. In addition there may be absence of the biceps reflex absent and sensory impairment. The condition may be confirmed by magnetic resonance imaging (MRI) which shows nerve root damage however electromyography (EMG) which records the extra-cellular field potentials produced by muscles and nerve root studies are not thought to be helpful in determining the extent of the damage. Erbs palsy can lead to lifelong disabilities, extensive therapies multiple surgical interventions, psychological difficulties, pain and financial hardship for both the parents and for the child in adulthood. Children who suffer from this condition can experience increasing disability with age and in due course suffer from arthritis and problems associated with overuse of other body parts in compensation for the disability.


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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here