Erb's Palsy Birth Injury

What Is Erb's Palsy?

Erb's palsy (also known as Erb-Duchenne palsy) is a form of brachial plexus injury that occurs during childbirth when the upper trunk nerves (C5-C6) of the brachial plexus are stretched, torn, or avulsed. The brachial plexus is a network of nerves that originates in the spinal cord and travels through the neck and shoulder into the arm, controlling movement and sensation in the shoulder, arm, and hand.

When these nerves are damaged, the baby is born with weakness or paralysis of the affected arm — typically the baby's arm hangs limp at the side with the palm rotated backward (the "waiter's tip" position). While some cases of Erb's palsy resolve spontaneously within months as nerves heal, others cause permanent disability requiring nerve graft surgery, tendon transfers, and years of physical and occupational therapy.

Erb's palsy affects approximately 1-2 per 1,000 live births. In many cases, the injury is preventable — caused by excessive traction or improper delivery technique during a difficult birth, particularly one complicated by shoulder dystocia.

Causes of Erb's Palsy

Excessive Traction During Delivery

The primary cause of Erb's palsy is excessive lateral traction (sideways pulling) on the baby's head and neck during delivery. When the obstetrician pulls too hard — particularly during a shoulder dystocia delivery where the baby's shoulder is impacted behind the mother's pubic bone — the brachial plexus nerves stretch beyond their elastic limit and tear.

The standard of care prohibits excessive traction. Instead, obstetricians are trained to use specific maneuvers (McRoberts, suprapubic pressure, Rubin, Woods' corkscrew) that reposition the mother and baby to free the impacted shoulder without pulling.

Shoulder Dystocia

Shoulder dystocia — when the baby's anterior shoulder becomes lodged behind the mother's pubic bone — is the most common scenario leading to Erb's palsy. When shoulder dystocia occurs, the obstetrician has approximately 5-7 minutes to resolve it before oxygen deprivation causes brain damage. The pressure to deliver quickly can lead to excessive traction if the physician is not properly trained in shoulder dystocia maneuvers.

Breech Delivery

Breech presentations (baby positioned feet-first or buttocks-first) increase the risk of brachial plexus injury because the arms may be extended above the head, causing traction on the brachial plexus during delivery. The standard of care for many breech presentations is cesarean section to avoid this risk.

Forceps and Vacuum Extraction

Operative vaginal delivery using forceps or vacuum extraction increases the risk of brachial plexus injury, particularly when excessive force is applied or when the instruments are used improperly.

Types of Brachial Plexus Injury

Neuropraxia (Stretch Injury)

The mildest form — the nerve is stretched but not torn. These injuries typically heal on their own within 3-6 months as the nerve recovers. Most Erb's palsy cases are neuropraxia.

Rupture

The nerve is torn but not at the spinal cord attachment. Ruptures do not heal on their own and may require nerve graft surgery — typically performed between 3-9 months of age if spontaneous recovery does not occur.

Avulsion

The most severe form — the nerve is torn from the spinal cord. Avulsions cannot be repaired directly and may require nerve transfer surgery (redirecting a less critical nerve to restore function to the affected arm). Avulsion injuries cause permanent disability in most cases.

Risk Factors for Erb's Palsy

Obstetricians should identify these risk factors before delivery and consider whether an elective cesarean section is appropriate:

• Fetal macrosomia: Baby estimated to weigh more than 4,000-4,500 grams
• Maternal diabetes: Increases the risk of macrosomia and shoulder dystocia
• Prior shoulder dystocia or brachial plexus injury: History increases recurrence risk
• Prolonged labor: Especially prolonged second stage
• Operative vaginal delivery: Forceps or vacuum extraction
• Post-term pregnancy: Delivering after 40 weeks increases baby size
• Maternal obesity: BMI greater than 30

Failure to identify these risk factors, failure to counsel about the option of elective C-section, or failure to have experienced personnel present for a high-risk delivery may constitute medical negligence.

Treatment of Erb's Palsy

Conservative Treatment

Many Erb's palsy injuries improve with conservative management:

• Physical and occupational therapy: Range of motion exercises to prevent joint contractures
• Splinting: To maintain proper arm positioning
• Regular assessment: By a pediatric neurologist or brachial plexus specialist

Surgical Treatment

If spontaneous recovery does not occur by 3-6 months, surgical intervention may be necessary:

• Nerve graft: Replacing a ruptured nerve segment with a nerve taken from another part of the body
• Nerve transfer: Redirecting a functioning nerve to restore function to the affected arm
• Tendon transfer: Re-routing tendons to improve arm function
• Osteotomy: Bone surgery to improve joint positioning

New York Legal Framework

Statute of Limitations — CPLR § 208 (Infancy Toll)

Under CPLR § 214-a, the general medical malpractice statute of limitations is 2.5 years. However, for injuries to infants, CPLR § 208 tolls the statute of limitations until the child's 18th birthday — but cannot extend the filing deadline beyond the child's 10th birthday in most cases.

Certificate of Merit — CPLR § 3012-a

Every malpractice complaint must include a Certificate of Merit confirming that a qualified medical expert (typically a board-certified obstetrician) has reviewed the case.

Wrongful Death — EPTL § 5-4.1

If the baby died during delivery, the family has 2 years from the date of death to file a wrongful death claim.

MDLaw Firm Results

• $4.5 million settlement for a child with permanent Erb's palsy caused by excessive traction during a shoulder dystocia delivery at a Brooklyn hospital
• $3.2 million settlement for a baby who required nerve graft surgery after an avoidable brachial plexus injury at a Manhattan hospital
• $2.8 million settlement for a child with avulsion-type Erb's palsy from a forceps delivery at a Bronx municipal hospital

(Prior results do not guarantee a similar outcome.)

Why Choose MDLaw

MDLaw Firm works with board-certified obstetricians and pediatric neurologists to review delivery records and identify where the standard of care was breached. We handle all birth injury cases on a contingency fee basis.

If your child was born with Erb's palsy or another brachial plexus injury in New York, contact MDLaw Firm at 347-524-5777 for a free consultation.