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Toronto Erbs Palsy Lawyers - Malpractice


TORONTO LAWYER HELPLINE: ☎ 855 804 7142



Most families simply don't have the resources to cover all the expenses and provide for a child victim of medical negligence over his or her lifetime. That's where our Erbs palsy lawyers come in to help your child receive the compensation they deserve. We ensure that your child gets a fair deal, by taking the guesswork out of selecting a lawyer. Our Toronto medical malpractice lawyers have a track record of successful verdicts and settlements in Erbs palsy compensation claim cases. They only deal with Erbs palsy compensation claims using a contingent fee arrangement which means that if you don't win then they don't get paid. Doctors usually provide a high standard of excellence for their patients however there are occasions when things do go wrong. If your child's condition resulted from clinical negligence, a specialist Toronto lawyer can help you assert your rights and get the compensation your child deserves. If you would like legal advice at mo cost on Erbs palsy compensation then just call the helpline or complete the contact form or email our Toronto office. An Erbs palsy lawyer, based in Toronto will contact you by telephone to discuss your claim.

Erb’s Palsy History

Erb’s palsy or Erb-Duchenne palsy or brachial plexus palsy involves some aspect of a paralysis of the main nerves of the arm, particularly the nerves that come from C5-C6 in the cervical spine. These nerves form the brachial plexus in the under arm area along with portions of C5-C8 and the thoracic nerve called T1. Almost every case of Erb’s palsy in infants occurs because of shoulder dystocia or the getting stuck of the shoulder during a problematic birth. If the shoulder is tugged on in such a way as to pull on or break the nerves of the brachial plexus, paralysis can result.

The first description of a brachial plexus palsy related to obstetrical delivery was described in William Smellie’s 1768 treatise on midwifery. The child he described had a condition of bilateral brachial plexus palsy in a newborn who suffered through a difficult delivery.

Then there was Guillaume Benjamin Amand Duchenne, who in 1861 came up with the term “obstetrical palsy of the brachial plexus”. He looked at 4 infants who had nearly identical arm limitations that stemmed from birth. In 1874, Wilhelm Heinrich Erb did a treatise explaining the palsies of adults who had brachial plexus palsy from birth. He also identified that the lesion was at the level of C5 and C6 and denied that the problem was from an isolated peripheral nerve lesion.

Erbs Palsy Cause

The main cause of Erbs palsy is shoulder dystocia, when the doctor pulls hard on one side of the fetal head in an attempt to slip a shoulder out of the birth canal. The head and neck are pulled to one side but the shoulders stay lodged in the birth canal so that there is excess tension on the nerves going from the cervical spine to the upper arm.

The condition can happen with a breech delivery in situations where the infant’s body are out but the head is stuck. Unnatural pulling on the arms can stretch the neck and can result in damage to the brachial plexus. A doctor can give an infant Erb’s palsy just by fracturing the infant’s clavicle even though dystocia might not exist.

Surprisingly, Erbs palsy can happen in a non-neonate whenever there is trauma to the head and shoulder with stretching of the nerves in the brachial plexus. Direct violent actions, like gunshot wounds and an assault with traction on the arm can cause Erb’s palsy. A doctor trying to reduce a dislocated shoulder can damage the brachial plexus and can cause Erb’s palsy to occur.

If you would like free advice from a specialist medical malpractice lawyer based in Toronto on Erbs palsy compensation claim settlements without further obligation just contact our offices.

Erbs Palsy Appearance

Erb’s palsy is a weakness or paralysis of part of the arm or the entire arm. The degree of arm paralysis depends on which nerves were injured and to what degree. For example, when just the upper arm is effected, doctor’s call it a brachial plexus injury. If both the upper and lower part of the arm is affected, doctor’s call it Erb’s palsy. If it affects the upper arm, the rotating aspect of the lower arm and the hand, doctor’s call it Klumpke paralysis. In this condition, the eyelid can droop on the eye opposite the side of the hand injury.

The arm paralysis can be complete or only partial. Each nerve root can be torn or just bruised. The most common nerve root involved in Erb’s palsy is C5, which is actually the connection between C5 and C6. It is the furthest point from the area of traction so that it gets the greatest amount of stresses placed on it. It is characterized as a lower motor neuron disease.

The nerves that are most commonly followed include the axillary nerve, the musculocutaneous nerve, and the suprascapular nerve. The child most likely will lose sensation in the affected arm and have paralysis of the arm, along with atrophy of the deltoid, the biceps and the bracialis muscles. The arm usually hangs by the side of the body and is rotated inward or medially. The forearm is completely extended and is pronated. The arm is unable to be abducted from the side of the body and the elbow flexion is completely lost. There is no supination ability in the forearm. In other words, the hand cannot be rotated palm-side up.

Children who are affected as an infant or newborn may have stunted growth from the shoulder to the fingers. Circulation and muscle function are completely impaired along with the nerve damage. They often can’t raise their arm above shoulder height, even though they technically have the nerves to do so in many situations. There won’t be any ability to regulate the temperature of the affected arm, which makes the arm cold and sometimes unreasonably cold in the wintertime. The child needs to be carefully watched when the weather is cold. In addition, the wound healing is slow in these children because of a lack of normal circulation and they often get infections of these wounds.

The worst problem in Erb’s palsy is a lack of nerve function due to permanent damage to the nerves. The most anesthetic area is the area between the shoulder and the elbow. Some children have total loss of anesthesia of the entire arm.

Severe Disability

Erbs palsy can cause severe disability and may be as a result of medical malpractice that allowed the child to be subjected to excessive trauma during labor or delivery. Erbs palsy is caused by an injury to the brachial plexus which is a network of nerves that run from the spine through the shoulder to the tips of the fingers. An Erbs palsy medical malpractice lawyer may be able to claim substantial compensation for this injury which can cause varying degrees of paralysis of the hand, arm or shoulder.

Damage to the brachial plexus nerves falls into three main clinical categories :-

    Neuropraxia is the mildest and most common form. Many infants born with brachial plexus injuries have neuropraxia and often recover spontaneously over a short period of time.

    Axonotmesis nerve damage causes a complete absence of sensation though recovery is fairly good.

    Neurotmesis is the greatest degree of nerve injury and one or more of the nerves in the brachial plexus may be affected. The prospects of recovery are poor.

Brachial Plexus

The brachial plexus is a network of nerves that runs from the spinal cord, across the shoulders and along the arms to the tips of the fingers. These nerves control movement and feeling and if the nerves are disrupted or damaged then disability can occur with full or partial loss of control of the arm. Less than 1% of new born infants suffer from this injury which is usually as a result of medical malpractice for allowing the child’s head to be subjected to excessive trauma during birth and delivery which causes the nerves to stretch, distend or rupture. There are recognized risk factors that will be considered by experienced erbs palsy lawyers in the event of a claim for medical malpractice. These risk factors which are associated with both the unborn child and the mother and include;

  • maternal diabetes
  • unusually large child
  • excessive traction used during delivery

Shoulder Dystocia

Most brachial plexus injuries are as a result of failure to manage shoulder dystocia which may occur during labor when the baby's shoulder gets trapped behind the mother's pelvic bone. There are well established protocols to deal with the problem and failure to follow recognized guidelines may result in severe injury or death. Medical malpractice claims instigated by erbs palsy lawyers for Brachial plexus injuries usually fall into two main categories;

  • negligent handling of shoulder dystocia - failure to follow established protocols
  • failure to arrange a c-section in appropriate cases

Nerve Injury

Children with this condition are affected in different ways and the amount of compensation that a lawyer can recover in an Erbs palsy medical malpractice case is dependent on the severity, duration and degree of the disability. There may be no muscle control or feeling in the arm or hand or little control over the wrist and hand. Some children are able to use their hands well but are unable use their shoulder or elbow muscles. Symptoms can range from mild to severe and temporary to permanent and are caused by four main different types of nerve injury which are :-

    Avulsion where the nerve is torn from the spine

    Rupture where the nerve is torn but not at the point of attachment to the to the spinal cord

    Neuroma where scar tissue has grown around an injured nerve causing the exertion of pressure on the nerve

    Praxis which is nerve damage falling short of a tear or rupture with improvement of function usually within 3 months

Brachial plexus injury is classified according to the type and extent of nerve damage as follows;

    Klumpke's Palsy characterized by a limp hand and immobile fingers often associated with Horners syndrome which is caused by damage to the sympathetic nervous system.

    Complete Brachial Plexus Palsy is characterized by paralysis of the entire arm often associated with Horner's Syndrome and Torticollis.

    Erbs Palsy is characterized by the arm being turned towards the body, with a stiff elbow and the hand in a ‘waiters tip’ position.

Diagnosis

Because the cause of Erb’s palsy is something that generally happens at the time of birth, it is usually diagnosed shortly after birth. What isn’t known at the time of birth, however, is the extent of the disease when the first year rolls around. The babies with Erb’s palsy do not have a Moro reflex on the side of the injury. This occurs by startling the infant and seeing the arms extend outward and upward. The affected arm does not extend as much and the palms are upward and the thumbs are flexed.

Some babies with Erb’s palsy hold the affected arm tight against the body and will hold the elbow flexed. There may be no grip strength on the affected side and the arm will grow to become smaller than the unaffected side.

If a child is diagnosed with visible signs of Erb’s palsy by the age of one year, these symptoms are likely to be permanent with no appreciable improvement in the symptoms of the disease.


Treatment


Simple stretching injuries of the cervical nerves will result in healing that occurs spontaneously by the time the infant is 6-12 months of age. Parents should do gentle massage of the affected arm and should do gentle range of motion of the arm so the arm doesn’t get arthritic or frozen. Physical therapy can be done in order to keep the muscles of the upper and lower arm strong until strength returns on its own. In the next paragraphs we will discuss tendon transplantation that is usually done when the baby is three to six months of age. Nerve injuries heal more slowly than, say, muscle injuries or other soft tissue injuries. Even if the child receives a tendon transplant, healing does not occur for another two years and, in some cases, there is prolonged injury and weakness to the affected extremity. Both strength and range of motion are permanently impaired.

While it’s true that some babies get better from Erb’s palsy on their own, other babies need physical therapy or other intervention to restore the functioning of their nerves. A neonatal specialist in pediatric neurosurgery may be necessary for situations where there is an avulsion fracture of the nerve. The nerves can be put back together and can slowly gain function. Children often recover by the time they reach their first birthday; those who have not completely recovered by this time rarely gain any functionality in their arm and develop secondary arthritis.

There are three main treatments for Erbs palsy. The first one is a nerve transplant taken from the opposite leg that can help connect nerve ends to nerve ends. The second one is a subscapularis release, which takes the tension off the damaged nerve. The third is what’s called a latissimus dorsi tendon release.

Nerve transplants are done on infants of age 9 months or younger. If they are done on children older than this, it can cause more harm than good and nerve damage can occur from the transplant site. There can also be scarring along the neck and shoulder that can be quite hideous in a child older than age 9 months.

Subscapularis release surgery can be done at any age. The surgeon simply performs a Z shaped incision into the subscapularis muscle to let the muscles stretch better. The strength and functionality of the muscle can be compromised in this type of procedure.

When the doctor does the latissimus dorsi tendon transfer, the latissimus dorsi muscle is cut in half horizontally and each end is pulled around in order to attach it to the outside of the biceps muscle. It allows the arm to externally rotate better. It has only a certain degree of success. There may be increased sensitivity in the biceps area where the latissimus dorsi is attached because there are excessive numbers of nerve endings in the area.

Complications

Erb’s palsy is most often due to stretching of the C5 and C6 cranial nerves and fortunately, most cases of this condition resolve spontaneously by the time the child reaches 6-12 months of age. Stretching exercises shock the nerves into working again but it can occasionally cause scar tissue to form around the nerve. In such cases, recovery may not be complete. If the nerves are torn, this is the most serious case scenario and there may not be any healing at all without surgical intervention. In rare situations, the nerve is avulsed or torn off the spinal cord and won’t heal without intervention. Fortunately, fewer than 10 percent of Erbs palsy cases at birth go on to result in a permanent paralysis or loss of sensation of the arm.

Toronto Erbs Palsy Lawyers

To succeed in a claim for compensation it is necessary for Toronto erbs palsy lawyers to show that it is more likely than not that their client has suffered injury which they would not otherwise have suffered but for negligent treatment by a health care professional. Treatment is negligent if a healthcare provider has fallen below the minimum standard of skill or care that the medical profession regards as reasonable in that particular area of the country. This includes not only doctors but also hospitals, clinics, dentists, nurses and technicians and any other party or body that undertakes to provide services to take care of patients sufficient to establish a duty of care. A doctor/patient relationship is usually sufficient for Toronto erbs palsy lawyers to establish the existence of a duty of care. If you would like advice at no cost from a specialist medical malpractice lawyer on Erbs palsy compensation claims without further obligation just contact our Toronto offices.



TORONTO LAWYER HELPLINE: ☎ 855 804 7142