Compassion, clarity, and strong advocacy for BPI
Brachial plexus injuries (BPI) can occur during labor and delivery, often when a baby’s shoulder becomes lodged behind the mother’s pubic bone after the head is delivered—a complication called shoulder dystocia. When shoulder dystocia is not managed according to established standards of care, excessive traction or improper maneuvers can stretch or tear the brachial plexus nerves, leading to weakness, loss of sensation, or paralysis in the shoulder, arm, or hand.
At McEldrew Purtell, our catastrophic injury team investigates whether preventable errors contributed to your child’s injuries and fights for the resources your family needs for therapy, surgeries, and lifelong support.
Definitions
What is Brachial Plexus?
The brachial plexus is a network of nerves originating in the neck (C5–T1) that controls movement and sensation in the shoulder, arm, and hand. Injury to these nerves can range from temporary neurapraxia (stretch injury) to avulsion (when the nerve root is torn from the spinal cord).
Common Clinical Presentations
1. Erb’s palsy (C5-C6): Shoulder and upper arm weakness, “waiter’s tip” posture.
2. Erb-Klumpke (C5-T1): Combined upper and lower plexus deficits.
3. Klumpke palsy (C8-T1): Hand and wrist weakness; may include Horner’s syndrome (ptosis, miosis) if sympathetic fibers are involved.
Signs Parents May Notice
Decreased grip strength on one side
A flaccid or weak arm
Asymmetric Moro reflex
Limited shoulder movement or hand posturing (e.g. “claw hand”)
What is Shoulder Dystocia?
Shoulder dystocia occurs when one or both of the baby’s shoulders become impacted behind the maternal pubic symphysis after the head delivers. This obstetric emergency demands coordinated, stepwise maneuvers to relieve the impaction without putting harmful lateral traction on the baby’s head and neck.
Why It Matters for BPI
Forceful traction or misuse of instruments (vacuum or forceps) during a dystocia can overstretch or tear the brachial plexus, causing temporary or permanent nerve damage.
Risk Factors (and their limits)
Risk factors can include fetal macrosomia (≈4,000 g or more), maternal diabetes, prior shoulder dystocia, prolonged second stage, and operative vaginal delivery. However, these factors do not reliably predict dystocia; providers must be prepared even when risk appears low.
Steps to Preventing Brachial Plexus Injuries
BPI prevention starts with the proper assessment of high-risk pregnancies. Risk factors include:
- Fetus positioned for breech birth
- Gestational diabetes
- Fetus weighing 9 pounds or more (macrosomia)
- Obesity in the mother or unusual pre-birth weight gain
- Small pelvis
- Previous history of BPI
How to Know if Medical Negligence is Responsible for Your Infant’s Injury
To prove medical negligence, it must be clearly established that a birth injury was the result of a breach of care on the part of the attending physician. In BPI cases, this could be reflected in a lack of attention given to BPI risk factors, a delay in ordering a timely C-section or directly causing the injury while delivering the baby.
Most often, establishing medical negligence requires the testimony of an expert medical witness, able to verify that the defendants’ conduct fell short of the accepted medical standard, and that this lapse in care was responsible for the infant’s injury.
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