Brachial Plexus Injury Lawyer New York: Erb's, Klumpke's & Total Palsy Claims

Types of Brachial Plexus Injuries

Brachial plexus injuries are classified by severity and by which nerve roots are affected. Understanding the type of injury is essential for both medical treatment and legal evaluation:

• Neurapraxia: The mildest form. The nerve is stretched but not torn. Most neurapraxias heal on their own within weeks to months.
• Rupture: The nerve is torn but remains attached to the spinal cord. Ruptures do not heal on their own and require surgical repair.
• Avulsion: The most severe form. The nerve root is torn completely from the spinal cord. Avulsions cannot be directly repaired and require nerve grafting or nerve transfer surgery. This type of injury often causes permanent disability.
• Neuroma: Scar tissue forms around a healing nerve, compressing it and preventing signal transmission. May require surgical removal of the neuroma.

Erb's Palsy (Upper Trunk Injury)

Erb's palsy — the most common brachial plexus birth injury — involves damage to the upper nerve roots (C5 and C6). The child's arm is typically held internally rotated at the shoulder and pronated at the forearm in a characteristic 'waiter's tip' position. The child may have weakness or inability to raise the arm, bend the elbow, or rotate the arm outward.

Erb's palsy most commonly occurs during shoulder dystocia, when the baby's anterior shoulder becomes stuck behind the mother's pubic bone after the head has delivered. The application of excessive lateral traction (pulling) on the baby's head to free the shoulder stretches or tears the upper brachial plexus nerves.

While many Erb's palsy cases resolve with physical therapy within the first 6-12 months, approximately 20-30% require nerve surgery (nerve grafting or nerve transfer) and some result in permanent disability despite treatment. [Link to: /birth-injury/erbs-palsy-lawyer]

Klumpke's Palsy (Lower Trunk Injury)

Klumpke's palsy involves damage to the lower nerve roots (C8 and T1), which control the hand and wrist. Children with Klumpke's palsy may have a 'claw hand' deformity — the hand is flexed at the wrist and fingers, with weakness or paralysis of the hand muscles. They may also have Horner's syndrome (drooping eyelid, constricted pupil) if the T1 sympathetic fibers are affected.

Klumpke's palsy is less common than Erb's palsy but often more disabling because the fine motor control of the hand is critical for daily activities — writing, typing, grasping objects, and self-care. Many Klumpke's palsy cases involve complete avulsion of the lower nerve roots, which means the nerves are torn from the spinal cord and cannot be directly repaired. These children may require nerve transfer surgery, tendon transfers, and lifelong therapy.

Total Brachial Plexus Palsy

Total brachial plexus palsy — also called global palsy — involves damage to all five nerve roots (C5-T1). The entire arm is flaccid (limp) with no movement or sensation. This is the most severe form of brachial plexus birth injury and often involves multiple avulsions. The child has no function in the affected arm at all.

Total palsy almost always requires nerve surgery and frequently results in permanent, significant disability despite treatment. The child may need multiple surgeries throughout childhood and adolescence — nerve transfers, tendon transfers, joint stabilization, and bone procedures — and will likely require lifelong assistance with activities of daily living.

How Brachial Plexus Injuries Happen During Childbirth

Brachial plexus injuries most commonly occur during the delivery of the baby's shoulders — specifically during shoulder dystocia, when the anterior shoulder becomes impacted behind the mother's pubic symphysis after the head has delivered. When this happens, the provider must use specific obstetric maneuvers to free the shoulder.

The injury occurs when the provider applies excessive lateral traction — pulling the baby's head sideways away from the impacted shoulder. This lateral force stretches or tears the brachial plexus nerves. The standard of care requires that the provider:

- Recognize shoulder dystocia promptly (the 'turtle sign' — the head retracts after delivery) - Call for help immediately (additional nursing and physician assistance) - Use appropriate maneuvers in a stepwise fashion: - McRoberts maneuver: Hyperflexing the mother's hips to rotate the pelvis and free the shoulder - Suprapubic pressure: Applying pressure above the pubic bone to rotate the shoulder (Rubin II maneuver) - Wood's screw maneuver: Rotating the baby's body to free the impacted shoulder - Delivery of the posterior arm: Reaching in and delivering the posterior arm first - Last-resort maneuvers: Intentional clavicle fracture, Zavanelli maneuver (replacing the head and performing cesarean), or symphysiotomy

Excessive traction should never be the primary maneuver. The standard of care, as established by the American College of Obstetricians and Gynecologists (ACOG), is that lateral traction must be minimized and that the provider should rely on maneuvers rather than force.

Shoulder Dystocia: The Leading Cause

Shoulder dystocia occurs in approximately 0.2% to 3% of vaginal deliveries. While it cannot always be predicted, certain risk factors significantly increase the likelihood:

- Fetal macrosomia: A baby weighing more than 4,000-4,500 grams (8 lbs 13 oz to 9 lbs 15 oz) has a higher risk of shoulder dystocia. [Link to: /birth-injury/macrosomia-malpractice] - Gestational diabetes: Babies of diabetic mothers tend to have larger shoulders relative to head size, increasing dystocia risk. - Prior shoulder dystocia: A history of shoulder dystocia in a prior delivery significantly increases recurrence risk. - Prolonged labor: A prolonged second stage of labor (pushing phase) may indicate a tight fit. - Post-term pregnancy: Post-term babies tend to be larger. - Operative vaginal delivery: Use of forceps or vacuum extraction increases dystocia risk.

When these risk factors are present, the standard of care requires the provider to anticipate the possibility of shoulder dystocia and have a plan in place — including additional personnel available, preparedness for cesarean delivery, and discussion of risks with the patient. Failure to anticipate and plan for shoulder dystocia when risk factors are present is a common form of negligence in brachial plexus injury cases.

Failure to Anticipate and Plan

In many brachial plexus injury cases, the negligence is not just what happened during the delivery — it is what happened (or didn't happen) before. When risk factors for shoulder dystocia are present, the provider must:

1. Identify the risk factors: Review the prenatal record for gestational diabetes, prior macrosomia, prior shoulder dystocia, obesity, and excessive weight gain. 2. Estimate fetal weight: Use clinical estimation and ultrasound (Leopold's maneuvers, fundal height measurement, and ultrasound biometry) to assess fetal size. While ultrasound estimates can be imprecise (±15-20%), they provide important information. 3. Counsel the patient: Discuss the risks of shoulder dystocia and brachial plexus injury, and the option of elective cesarean delivery when fetal macrosomia is suspected (especially in diabetic mothers). 4. Prepare for the possibility: Ensure adequate personnel are available, and have a shoulder dystocia protocol ready.

When a provider fails to recognize these risk factors and proceeds with a vaginal delivery that results in a brachial plexus injury, the failure to anticipate and plan may constitute negligence — particularly when an elective cesarean would have avoided the injury entirely.

When a Brachial Plexus Injury Constitutes Malpractice

Not every brachial plexus injury is caused by medical negligence. Some occur despite appropriate care, even when the provider follows the standard of care. However, brachial plexus injuries constitute medical malpractice when one or more of the following occurred:

- Excessive lateral traction: The provider pulled the baby's head too hard or at the wrong angle, directly causing the nerve injury. This is the most common form of negligence. - Failure to use appropriate maneuvers: The provider did not use McRoberts, suprapubic pressure, or rotational maneuvers before resorting to traction. - Failure to call for help: The provider did not call for additional assistance when shoulder dystocia was identified. - Failure to anticipate shoulder dystocia: The provider did not identify risk factors for shoulder dystocia and plan accordingly, including failing to offer elective cesarean delivery when macrosomia was present in a diabetic mother. - Failure to perform a timely cesarean: When labor was prolonged or not progressing, or when the baby showed signs of distress, and the provider did not perform a cesarean. - Improper use of forceps or vacuum: When operative vaginal delivery was contraindicated or improperly performed, contributing to the shoulder dystocia and nerve injury. - Inadequate documentation: The delivery note does not document the shoulder dystocia, the maneuvers used, or the amount of traction applied — which may itself be evidence of substandard care.

To prove malpractice, expert testimony from a board-certified obstetrician is required. The expert must testify that the provider's conduct fell below the standard of care and that this breach caused the nerve injury.

Diagnosis and Treatment

Brachial plexus injuries are usually apparent shortly after birth — the affected arm may be limp, held in an abnormal position, or not moving. Diagnosis and evaluation typically include:

- Physical examination: Assessment of arm movement, muscle tone, reflexes, and sensation. The presence of Horner's syndrome (eyelid drooping, pupil constriction) may indicate a lower trunk avulsion. - Imaging: MRI or CT myelography may be used to evaluate nerve root integrity and identify avulsions (pseudomeningoceles on imaging indicate root avulsion). - Electrodiagnostic studies: EMG and nerve conduction studies assess nerve function and help predict recovery.

Treatment depends on the severity of the injury: - Physical and occupational therapy: Started immediately to prevent joint contractures and maintain range of motion. Many mild injuries (neurapraxia) recover with therapy alone. - Nerve surgery: For injuries that do not show recovery by 3-6 months, nerve grafting (replacing a torn nerve with a donor nerve) or nerve transfer (redirecting a working nerve to a damaged nerve's target muscle) may be indicated. Surgery is most effective when performed by 6-12 months of age. - Secondary procedures: Tendon transfers, bone procedures, and joint releases may be needed later in childhood to improve function.

Long-Term Consequences

The long-term consequences of a brachial plexus injury depend on the severity of the nerve damage and the effectiveness of treatment:

• Permanent weakness or paralysis: Despite surgery and therapy, some children have permanent weakness or paralysis of the affected arm, limiting their ability to perform daily activities.
• Joint contractures: Tightness and shortening of muscles and joints, particularly internal rotation contracture of the shoulder, which limits arm movement.
• Bony deformities: Growth disturbances can cause limb length discrepancies and joint deformities (e.g., posterior shoulder dislocation).
• Scoliosis: Asymmetric muscle weakness can lead to spinal curvature.
• Psychological impact: Children with visible disabilities often experience self-esteem issues, social challenges, and emotional distress.
• Career limitations: The affected arm's disability may limit career choices and earning potential.
• Ongoing medical costs: Multiple surgeries, years of therapy, and ongoing medical care can cost hundreds of thousands of dollars over a child's lifetime.

New York Statute of Limitations

Under New York CPLR § 214-a, the statute of limitations for medical malpractice is 2.5 years from the date of the negligent act. However, for birth injuries involving minors, the infancy toll (CPLR § 208) extends this deadline: the statute of limitations does not begin to run until the child's 18th birthday, giving the child until age 20 (18 + 2.5 years) to file a lawsuit on their own behalf.

However, parents who are seeking to recover their own economic damages (medical expenses, lost wages) have a separate 2.5-year statute of limitations from the date of the injury that is not tolled during the child's minority. This means parents must file their claims within 2.5 years of the birth, while the child has until age 20 to file their own claim for future damages (pain and suffering, future medical expenses, loss of earnings).

For claims against municipal hospitals (NYC Health + Hospitals, including Bellevue, Kings County, etc.), a Notice of Claim must be filed within 90 days of the incident under General Municipal Law § 50-e, and the lawsuit must be filed within 1 year and 90 days. [Link to: /birth-injury/statute-of-limitations]

Building Your Case

To build a successful brachial plexus injury malpractice case, MDLaw Firm will:

1. Obtain and review all medical records: Including prenatal records, labor and delivery records, fetal monitoring strips, operative notes, nursing notes, pediatric records, and physical therapy records. 2. Consult with medical experts: Board-certified obstetricians, pediatric neurologists, and orthopedic surgeons review the records and provide opinions on whether the standard of care was breached and whether the breach caused the injury. 3. Analyze the delivery: Reconstruct the delivery timeline — when was shoulder dystocia identified, what maneuvers were used, how much time elapsed, and what documentation exists. 4. Assess damages: Work with a life care planner to project the child's future medical needs, therapy, surgical interventions, and assistive care costs. [Link to: /birth-injury/case-results] 5. File the lawsuit with a certificate of merit: Under CPLR § 3012-a, the complaint must include confirmation that a qualified medical expert reviewed the case. 6. Pursue discovery and trial preparation: Depose the delivery providers, obtain expert testimony, and prepare for trial or settlement negotiation.

We handle brachial plexus injury cases on a contingency fee basis — you pay nothing unless we recover compensation for your child.

Frequently Asked Questions

The value of a medical malpractice case in New York depends on several factors, including the severity of the injury, the strength of liability evidence, and the economic and non-economic damages involved. New York is one of the few states with no caps on medical malpractice damages, meaning there is no artificial limit on what you can recover. Below are typical settlement ranges based on injury severity.