Item: Miller & Zois, Attorneys at Law
Rating: 5
Author: Terry Waldron

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.

Common Risk Factors for Brachial Plexus Injuries

Brachial plexus injuries during childbirth are often preventable when doctors take appropriate steps to identify and manage known risk factors. These injuries, which result from excessive force during delivery, are more likely to occur when certain conditions are present. Understanding these risk factors help us better understand what medical professionals need to do to meet the standard of care to anticipate possible complications and take measures to avoid harm.

Fetal Macrosomia

Fetal macrosomia, or having a baby larger than 4,000 grams (about 8.8 pounds). Again, size is a leading risk factor for brachial plexus injuries. Larger babies are more prone to complications during vaginal delivery, particularly shoulder dystocia, where the baby’s shoulder becomes stuck behind the mother’s pelvic bone. In such cases, improper delivery techniques can overstretch or tear the delicate nerves of the brachial plexus.

Doctors have a responsibility to estimate the baby’s size through ultrasounds and other assessments during pregnancy. When fetal macrosomia is suspected, they should counsel the mother about the risks associated with a vaginal delivery and seriously consider recommending a cesarean section to reduce the likelihood of injury.

Maternal Diabetes

Maternal diabetes, including gestational diabetes, increases the risk of delivering a larger baby, which in turn raises the chance of brachial plexus injuries. Uncontrolled blood sugar levels can contribute to fetal macrosomia and other complications that make vaginal delivery riskier.

Medical professionals must monitor maternal blood sugar levels closely throughout the pregnancy and provide guidance on managing diabetes. When the baby’s size suggests potential delivery risks, doctors should be prepared to recommend and perform a C-section to protect both mother and baby.

Prolonged Labor or Difficult Delivery

Prolonged labor or delivery that does not progress as expected can increase the risk of brachial plexus injuries. Extended labor creates more opportunities for complications, including the need for forceful maneuvers or tools like vacuum extractors or forceps, which can cause nerve damage when improperly used.

Doctors have an obligation to monitor the progress of labor and intervene when the baby is telling them through the fetal heart monitor that there is a problem. This may involve a vacuum or forceps. But they must be ready to switch to a C-section when the risk to the baby becomes significant. Failure to act promptly or appropriately can lead to preventable injuries.

Abnormal Fetal Position

The position of the baby during delivery also plays a critical role in the risk of brachial plexus injuries. Babies in breech (feet-first) or posterior (facing up) positions may face additional challenges during birth, increasing the likelihood of nerve damage if excessive force is applied.

Doctors should assess the baby’s position during prenatal care and use techniques such as external cephalic version (ECV) to reposition a breech baby when possible. If the baby’s position poses too great a risk for a safe vaginal delivery, planning a C-section is often the safest option.

Shoulder Dystocia

Shoulder dystocia, where the baby’s shoulder becomes trapped during delivery, is one of the most common causes of brachial plexus injuries that doctors are trained to manage. This complication requires immediate and skillful management to avoid harm. Excessive traction or force during delivery can cause severe nerve injuries, including avulsions, which are particularly devastating and often permanent.

Doctors must anticipate the possibility of shoulder dystocia in high-risk cases and have a clear plan for managing it. Using well-established techniques like the McRoberts maneuver or applying suprapubic pressure can safely resolve shoulder dystocia without causing nerve damage. Above all, they must avoid the use of excessive force, which is a leading cause of these injuries.

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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Brachial Plexus Injury Compensation Amounts

Below are summaries of verdicts and reported settlements in actual brachial plexus birth injury cases.

2024, Illinois: $75,859,000 Verdict. The baby allegedly suffered multi-level injuries to her brachial plexus, a complete transverse fracture of her right humeral shaft, a metaphyseal fracture of her proximal left humerus, scalp swelling, a fracture of her right occipital bone, and intracranial bleeding, including a subdural hematoma, cerebellar hemorrhage, and subarachnoid hemorrhage. The plaintiff asserted medical negligence, including executing an internal podalic version when there was no clinical indication, failing to properly supervise the resident, failing to confirm the resident was pulling the plaintiff’s feet instead of her hand, failing to provide the mother uterine relaxation medication, and using excessive force to deliver the plaintiff.
2023, Missouri: $2,840,000 Verdict. The infant suffered a brachial plexus injury to his right upper extremity during delivery. The lawsuit alleged that shoulder dystocia was encountered during labor and that the defendant OB/GYN was negligent in her response to this complication. The lawsuit claimed that the defendant used excessive force in trying to dislodge the baby, resulting in the nerve injury.
2023, New Jersey: $150,000 Settlement. The plaintiff, a female infant, suffered a brachial plexus injury allegedly resulting in permanent impairment when shoulder dystocia was encountered during delivery. The lawsuit accused the doctor of negligently handling the complication.
2022, Louisiana: $15,800,000 Verdict. During delivery, the baby suffered a brachial plexus injury to his left shoulder and C5-C7 spinal nerve damage. The injury allegedly left him permanently disabled with a left arm significantly smaller than the other. The lawsuit asserted that the defendants were negligent in failing to recognize that the pregnancy was at high risk for fetal macrosomia and shoulder dystocia, and failing to opt for a c-section.
2022, New York: $2,537,354 Settlement. An/GYN was delivering a baby when shoulder dystocia was encountered. The plaintiff suffered a brachial plexus injury and was diagnosed with Erb’s palsy and underwent two surgeries to treat his injury. The lawsuit claimed that the defendant was negligent in failing to prepare for the possibility of shoulder dystocia, despite multiple risk factors, and then mishandling it when it occurred.
2021, New York $250,000 Settlement. Medical malpractice action was brought on behalf of male infant N.S. who reportedly suffered a brachial plexus injury during his birth at defendant’s hospital. The lawsuit alleged that shoulder dystocia was encountered during the delivery, which the defendant’s staff failed to correctly manage. The lawsuit claimed that claimed the defendant used excessive force while delivering him vaginally when shoulder dystocia was encountered; failed to access fetal size and maternal pelvic outlet size; applied excessive traction, rotation, and pressure to the infant’s head and cervical spine; failed to properly perform maneuvers and performed inadequate maneuvers
2021, New Jersey $1,300,000 Settlement. The infant plaintiff suffered cervical spine and right brachial plexus injuries resulting in a permanently debilitating condition of Erb’s Palsy, during his labor and delivery, performed by the defendant.
2020, New York: $365,000 Settlement. A baby girl sustained a brachial plexus injury during her delivery. She eventually developed Erb’s palsy. Her father alleged that the obstetrician’s negligence caused her permanent injury. The parties disputed the damages. This case settled for $365,000. We do not have a lot of details in the case. But we can safely assume that the plaintiff’s case had real holes for the settlement to be so low.
2019, New York: $18,079,716 Verdict. This is a pretty classic fact pattern. A baby girl was born with Erb’s palsy and permanent brain damage from respiratory distress. Because of her injuries, the girl experienced limited right arm use, cognitive impairments, and an inability to speak. She required the permanent assistance of an aide. The family hired a birth injury lawyer and filed a lawsuit alleging that the hospital staff failed to treat her brachial plexus injury and respiratory distress. She argued that a timely ordered C-section would have reduced the brachial plexus injury risk. The woman also argued that timely administering steroid medications would have treated respiratory distress. The hospital argued that a C-section would not have diminished the brachial plexus injury risk. The hospital also argued that the baby’s brain damage and respiratory distress were unrelated. A jury found the hospital liable and awarded $18,079,716.
2018, California: $9,900,000 Settlement. A baby girl suffered a brachial plexus injury and brain damage during delivery. She ultimately developed spastic quadriplegia. Her parents field a brachial plus injury lawsuit that alleged that the mismanaged vacuum-assisted delivery caused her permanent injuries. They claimed the hospital staff failed to timely treat fetal distress and timely order a C-section. As you are seeing and will see, the failure to order a Cesarean section is a common motif in Erb’s palsy injury medical malpractice claims. The case settled for $9,900,000.
2018, Indiana: $2,000,000 Verdict. A macrosomic baby suffered a subdural hematoma, a brachial plexus injury, and a permanent brain injury during delivery. He developed left arm paralysis. His mother alleged that the hospital mismanaged the delivery. She claimed the obstetrician failed to recognize the macrosomia risk, negligently administered Pitocin, and improperly treated shoulder dystocia. The obstetrician denied liability. He argued he met the standard of care. A jury awarded a $2,000,000 verdict.
2018, Virginia: $2,320,335 Verdict. A baby boy sustained a right brachial plexus injury during his delivery. Because of this injury, he had limited use of his right arm. His mother alleged that the hospital’s mismanaging of his birth caused his permanent injury. She claimed the obstetrician negligently used excessive force to treat shoulder dystocia. The obstetrician argued that the woman’s contractions and pushing caused the injury. A jury awarded $2,320,335.
2017 New Jersey: $900,000 Settlement. OB/GYN allegedly uses excessive lateral traction to deliver the baby vaginally despite shoulder dystocia. Standard of care called for an emergency C-section once shoulder dystocia was diagnosed. The case resolved for a $900,000 settlement payout.
2016, Florida: $4,821,000 Verdict. Plaintiff is giving birth to her daughter at the hospital. During the birth, defendants encounter shoulder dystocia and apply excessive traction to the infant’s head. The infant is diagnosed with a brachial plexus injury and a rupture of two discs in her back due to the excessive traction applied during the delivery. The infant has permanent loss of function in her right arm. A jury found that the midwife was 60% negligent and that the doctor was 40% negligent and awarded the plaintiff $4,821,000.
2016, Connecticut: $4,200,000 Verdict. A woman is under the care of the defendants for pregnancy and delivery. The midwife fails to diagnose the infant’s shoulder dystocia during labor and delivery. During the delivery, it becomes apparent that the shoulders are not delivering, so the midwife uses lateral traction to push the infant’s head down and twist the head to release the shoulder. This results in a brachial plexus injury to the infant, and the infant has limited use of her arm and shoulder. The parents hire a brachial plexus lawyer and file a lawsuit alleging negligence in failing to diagnose the mother., As a result, the infant suffered permanent injuries due to excessive traction during delivery. A jury awards the infant and her parents $2,360,000 for loss of enjoyment of life, $840,000 for pain and suffering, and $1,000,000 for permanent injury.
2016, Illinois: $2,814,338 Verdict. A woman is giving birth to her son when the defendant doctors fail to check prenatal blood sugar levels and fail to recommend or offer the woman a Cesarean section. Instead, the defendants use excessive traction during the birthing process, and the infant suffers a brachial plexus injury due to shoulder dystocia that he endured during the delivery. The defendants deny, but a jury awarded the plaintiffs $2,814,338.
2016, Texas:$2,700,000 Verdict. A woman receives treatment from defendants during her pregnancy. When it comes time to deliver her infant, the fetus is found to be larger than the average size. Despite this finding, the defendants do not recommend a C-section. The defendant encounters shoulder dystocia during the delivery, and the fetus is delivered with a severe brachial plexus injury. Plaintiffs allege that the infant is permanently disabled and that the defendants should have performed a C-section once they realized the size of her fetus. The defendants denied negligence, but a jury awards the plaintiffs $2,700,000.
2016, New York:$2,000,000 Settlement. A woman gives birth to her daughter via vaginal delivery under the defendants’ care. Shoulder dystocia is encountered, but the defendants fail to perform the appropriate maneuvers to deliver the girl. The woman claims that the defendants should have recognized the increased risk of shoulder dystocia due to the size of her fetus and her gestational diabetes. As a result, the infant suffers right Erb’s palsy, a brachial plexus injury, and a left humerus fracture. The defendants denied liability but settled the case for $2,000,000.
2016, New York:$1,228,261 Settlement. Plaintiff receives prenatal care from the defendants. They fail to diagnose and treat fetal distress. The infant is not delivered via C-section, and shoulder dystocia is encountered. The infant suffers a birth-related neurological injury, brain damage, Erb’s palsy, brachial plexus injury, seizure disorder, and stroke. The hospital settled with the plaintiff for $1,228,261. The case against the doctor went to trial and a jury found in favor of the defendant.2016, New York: $1,184,162 Settlement. A woman is giving birth to her son under the care of the obstetrician/gynecologist. Defendant fails to perform a C-section promptly, and as a result, the infant suffers a left brachial plexus injury and mid-shaft humeral fracture during the delivery. The parents file this lawsuit, and the parties settle the claims for $1,184,162.

2016, New Jersey:$1,000,000 Settlement. A woman is giving birth to her baby when the defendant uses excessive traction. He uses a vacuum to deliver the baby to avoid brain damage, but he encounters shoulder dystocia as well. As a result, the infant suffers a right brachial plexus injury and Erb’s Palsy. The defendant argues that the brachial plexus injury did not occur due to excessive force. At four months old, the child has surgery, which provides her with relatively good movement at waist level, but she cannot move one of her arms. The parties settle before the trial started for the defendants’ insurance policy limits of $1,000,000.
2016, California:$950,000 Settlement. A woman is admitted to the defendant hospital to deliver her infant. Defendants diagnose gestational diabetes, but they do not inform the mother. They fail to inform the woman of the risks of gestational diabetes or the fact that since during a prior birth, shoulder dystocia was involved so her risks of reencountering it are increased. Additionally, the infant is heavier than average, which also points to the requirement of a C-section instead of vaginal birth. They fail to offer her a C-section. During delivery, shoulder dystocia occurs. This leads to severe brachial plexus paralysis of the infant’s arm, shoulder, and hand. The parties settled the case for $950,000.
2016, New York:$709,485 Settlement. A woman is giving birth to her daughter, during which shoulder dystocia is encountered. The defendants fail to properly address this and fail to deliver the infant by C-section, causing a brachial plexus injury. As a result, the infant suffers neurological damage, brain damage, and cognitive delays. The parties settle the case for $709,485.
2016, California: $450,000 Settlement. During delivery, the baby should be stuck. Classic case. They fail to deliver the baby safely, resulting in shoulder dystocia and permanent right brachial plexus paralysis. The defendants argue they did not deviate from the standard of care, but they settle the case for $450,000.
2015, Oregon: $1,012,000 Verdict. While a woman is giving birth to her daughter, defendants apply pressure and urge her to continue to push harder. Defendants use excessive traction during the delivery, and as a result, the infant suffers brachial nerve root avulsions leaving her with minimal use of her left arm and shoulder. A jury awards the woman $312,000 for economic damages and $700,000 for noneconomic damages.
2015, Pennsylvania:$975,000 Settlement. A woman has several ultrasounds towards the end of her pregnancy, indicating that her fetus is large. She is allowed to continue her pregnancy without scheduling an induction. Her membranes rupture, and she goes to the hospital, where she comes under the defendants’ care. They deliver her baby, during which shoulder dystocia is encountered. Defendants use a vacuum and push on the woman’s stomach, breaking the infant’s arm. The baby suffers a broken arm and a permanent brachial plexus injury, and the woman claims that the defendants should have recognized that her fetus would be large and offered a C-section. The parties settled for $975,000.
2015, New York:$950,000 Settlement. The defendant is delivering a woman’s baby when he encounters shoulder dystocia. The defendant is unsuccessful in alleviating the shoulder dystocia, and he applies excessive traction. As a result, the infant suffers Erb’s Palsy, a permanent injury to her brachial plexus nerve, and a developed elbow contraction from Erb’s Palsy. The defendant denied liability but settled the claims for $950,000.
2014, California:$5,510,757 Verdict. A mother is giving birth to her daughter when defendants fail to diagnose the obstructed delivery. Defendants use suction cups to assist the delivery, without diagnosing the reason for the block. As a result, the infant suffers damage to her brachial plexus nerve group, and she permanently loses mobility in her left arm. A jury awards the plaintiffs compensation of $5,510,757, later reduced to $801,205 by California’s malpractice cap.
2014, Massachusetts:$1,000,000 Settlement. The plaintiff has a history of shoulder dystocia, which is not documented in her medical records. Defendants fail to inform her of the risks associated with a vaginal birth due to her history. As a result, when she is giving birth, her infant suffers a permanent brachial plexus injury. The woman claims that if she had been informed of the risks, she would have opted to deliver her baby via C-section. Despite what so many doctors try to argue, it is pretty clear that C-sections reduce the risk of a brachial plexus injury. The parties settled the case for $1,000,000.
2014, Illinois:$500,000 Settlement. A woman is giving birth to her child at the hospital when the doctors place excessive traction on the infant’s head and neck, failing to recognize the woman’s risk factors for shoulder dystocia. As a result, the girl suffers a brachial plexus injury. The defendants deny liability but settle the claim for $500,000.

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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.

★★★★★

They quite literally worked as hard as if not harder than the doctors to save our lives. Terry Waldron

Ron helped me find a clear path that ended with my foot healing and a settlement that was much more than I hope for. Aaron Johnson

Hopefully I won't need it again but if I do, I have definitely found my lawyer for life and I would definitely recommend this office to anyone! Bridget Stevens

The last case I referred to them settled for $1.2 million. John Selinger

I am so grateful that I was lucky to pick Miller & Zois. Maggie Lauer

The entire team from the intake Samantha to the lawyer himself (Ron Miller) has been really approachable. Suzette Allen

The case settled and I got a lot more money than I expected. Ron even fought to reduce how much I owed in medical bills so I could get an even larger settlement. Nchedo Idahosa

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