Cerebral Palsy, Erb's Palsy & Birth Injury Blog

The results of a long-term study focusing on the outcome of infants that suffered a brachial plexus injury (bpi) or erbs palsy at birth were published in the January 2007 issue of The Journal of Bone and Joint Surgery.

The study followed up on children that underwent surgery for a bpi (mean of 13.3 years after surgery). The researchers studied 1706 children with brachial plexus injuries sustained at birth that required medical intervention between 1971 and 1997. Of these patients, 124 (7.3%) underwent surgery on the brachial plexus at a mean age of 2.8 months (range, 0.4 to 13.2 months). The most commonly performed surgical procedure was direct neurorrhaphy after neuroma resection.

The researchers found that approximately one-third of the patients, including all nine with a clavicular nonunion from the surgical approach, experienced pain in the affected limb. Additionally, all except for four patients used the hand of the unaffected arm as the dominant hand. Shoulder function was moderate, with a mean Mallet score of 3.0. Both elbow and hand function were good, with a mean score on the Gilbert elbow scale of 3 and a mean Raimondi hand score of 4. Incongruence of the glenohumeral joint was noted in sixteen (16%) of the ninety-nine patients in whom it was assessed, and incongruence of the radiohumeral joint was noted in twenty-one (21%). The extent of the brachial plexus injury was found to be strongly associated with the final shoulder, elbow, and hand function in a multivariate analysis.

Furthermore, a significant number of the patients continued to need help performing activities of daily living and had pain in the affected arm, with the pain due to a clavicular nonunion in one-fourth of the patients.

As a side note, I want to say that although this study appears to be harsh, erb’s palsy can present in wide spectrum of severity. That being said, these results seemed to me, to be preformed on the more severe cases of erb’s palsy. Finally, the most determinant prognostic factor predicting the outcome of children affected by a bpi appears to be the extent of the primary injury.

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Posted In: Erb's Palsy

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This is a medical animation of a vaginal delivery with the occurrence of shoulder dystocia which may lead to Erb’s palsy.

When shoulder dystocia is encountered the doctor should perform several procedures (such as the McRoberts Maneuver, Woods Maneuver etc.) to dislodge the shoulder. This will avoid or mitigate damage to the brachial plexus (an arrangement of nerve fibers running from the spine (C5-T1), through the neck, the axilla, and into the arm).

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Posted In: Erb's Palsy , Medical Malpractice

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When a child gets diagnosed with cerebral palsy or erb’s palsy the question of where to go for the best treatment soon follows. Below is a list of the top pediatric hospitals compiled by U.S. News & World Report.

America's Best Children's Hospitals, 2007 Edition
Published by U.S.News & World Report

1. Children's Hospital of Philadelphia
2. Children's Hospital Boston
3. Johns Hopkins Hospital, Baltimore
4. Children's Hospital, Denver
5. Rainbow Babies and Children's Hospital, Cleveland
6. Texas Children's Hospital, Houston
7. Cincinnati Children's Hospital Medical Center
8. New York-Presbyterian Univ. Hosp. of Columbia and Cornell
9. Children's Hospital and Regional Medical Center, Seattle
10. Lucile Packard Children's Hospital, Palo Alto, Calif.
11. Children's National Medical Center, Washington, D.C.
12. Columbus Children's Hospital
13. Children's Hospital of Pittsburgh of UPMC
14. Children's Healthcare of Atlanta
15. St. Louis Children's Hospital
16. UCSF Children's Hospital, San Francisco
17. Childrens Hospital Los Angeles
18. Primary Children's Medical Center, Salt Lake City, Utah
19. Duke University Medical Center, Durham, N.C.
20. St. Jude Children's Research Hospital, Memphis
21. Mattel Children's Hospital at UCLA, Los Angeles
22. University of Michigan C.S. Mott Children's Hospital, Ann Arbor
23. Vanderbilt University Medical Center, Nashville
24. Long Island Jewish Medical Center, New Hyde Park, N.Y.
25. Children's Memorial Hospital, Chicago
26. Miami Children's Hospital
27. Children's Hospitals and Clinics of Minnesota, Minneapolis
28. Children's Medical Center Dallas
29. Mayo Clinic, Rochester, Minn.
30. Children's Hospital of Wisconsin, Milwaukee

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Posted In: Cerebral Palsy , Erb's Palsy , Spina Bifida

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After deliberating for less then an hour a Virginia Beach Circuit Court jury returned a verdict of just under $2 million against a physician at Chesapeake General Hospital. The plaintiff alleged that the obstetrician mismanaged the baby's shoulder dystocia by applying excessive traction to the baby's head resulting in Erb's palsy. The child suffered serious injuries including avulsion of nerve roots at one level and ruptured nerve roots at multiple other levels.

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Posted In: Erb's Palsy , Medical Malpractice

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This touching video was made by Allison Steigerwalt - Mom to Bradley. The message she wants to convey is that “this injury CAN be prevented” with proper medical care. Although treatment, including surgery can mitigate the damage caused by shoulder dystocia, often, Erb’s palsy is a life long condition. This injury can be prevented through education, so please share your knowledge of shoulder dystocia and Erb’s palsy with expecting mothers to ensure they discuss the potential risk factors with their doctors, as the doctors often overlook them which leads to the injury.

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Posted In: Erb's Palsy , Medical Malpractice

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The New England Journal of Medicine recently published an article entitled Cesarean Delivery and the Risk–Benefit Calculus by Jeffrey L. Ecker, M.D., and Fredric D. Frigoletto, Jr., M.D. This article explains several reasons for an increase of cesarean deliveries over the past several years.

The article states that from 1937 to 2005 there has been an increase in c- sections of 1000% (10 times), in fact, as of 2005 nearly 30% of all deliveries are by C-section. If this trend continues many potential birth injuries such as, cerebral palsy and erb's palsy will be avoided. I believe the increase is due to three factors.

The first factor is the advance in medical treatment for the mother. In 1937, 6% of patients died after cesarean delivery, this has decreased by a factor of nearly 1000 due to modern antibiotics, anesthetic techniques, blood banks, and critical care units. As the risk decreases for the mother more doctors and mothers are willing to deliver via c-section.

Next, the advances of prenatal care and prenatal technology such as ultrasound and fetal heart monitoring have lead to an increase in cesarean deliveries. With new technology doctors are better equipped to determine if the fetus is in distress, may become distressed or may have difficulty progressing in a vaginal birth, thus, avoiding many birth injuries such as Erb’s Palsy and hypoxia which leads to Cerebral Palsy.

Finally, as medical treatment advances women that would not have otherwise been able to conceive are getting pregnant, and at advanced ages.

“…there has been a 3.8-year increase since 1970 in the mean age at first delivery, and since 1990, births to women 35 to 39 years of age and 40 to 44 years of age have increased by 43% and 62%, respectively. In addition, the number of premature and low-birth-weight neonates has increased, in part as a function of the increasing number of multiple gestations (121,246 in 2001 vs. 68,339 in 1980), many of which have resulted, in turn, from the use of assisted reproductive technology — assistance necessitated in many cases by advancing maternal age.”

I believe as technology increases so too will the rate of cesarean deliveries.

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Posted In: Cerebral Palsy , Erb's Palsy , Medical Malpractice

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Jayne Matthews of the Baltimore Times recently wrote a heart warming story describing how The Parents’ Place of Maryland (a group comprised exclusively of parents of a child with a learning or developmental disability) began and how the effort continues. In her latest article Matthews describes some of the emotions parents of disabled children go through and the amazing efforts made by The Parents’ Place of Maryland to assist the parents and children.

Matthews discusses how, unfortunately, parents of disabled children often feel isolated by feelings of “distress of a bleak prognosis” coupled with “anxiety over the future (how will my child survive a lifetime of limitations?)” and “guilt of the past (did I do something to cause this?)” and a “sense of anger (why is this happening to my family?).”
Matthews further explains how The Parents’ Place of Maryland, Josie Thomas, Kim McKay, Kelly Meissner and so many others have helped over 45,000 families since its inception in 1990.

For the full article click Here.

The resources are offered to the children and parents of children with disabilities throughout Maryland, regardless of the nature of their child's disability or the age of their child. They include conducting regular parent education courses and workshops, helping parents find information, providing referrals to other individuals or organizations, working with parents directly to help them obtain the best possible services for their children, maintaining an up-to-date list of support groups for parents in Maryland and publishing a quarterly newsletter for everyone interested in childrens' needs

This is a great organization and I applaud their effort.

Here is their contact info:

Parents' Place of Maryland
801 Cromwell Park Drive, Suite 103,
Glen Burnie, MD 21061

Telephone (voice or TDD): (410) 768-9100
FAX: (410) 768-0830
Email: info@ppmd.org

http://www.ppmd.org/index.asp

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Posted In: Cerebral Palsy , Erb's Palsy , Spina Bifida

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Erbs or Brachial Plexus Palsy has an occurrence rate in the USA of approximately 3 live births per 1,000. This condition is most commonly caused at birth by an injury to a network of inter-joining nerves in the head, neck, and shoulders. Erbs Palsy often occurs in larger children (due to their difficulty passing the mother's pubic bone) when excessive pressure is put on a child's head, neck, or shoulder during delivery.

Symptoms of Erbs or Brachial Plexus Palsy include: complete or partial paralysis or limpness in a child's arm, limited or no movement in a hand and/or fingers, or loss of feeling in the hands and/or fingers.

Treatment exists for children with these conditions and includes immobilization of the arm, physical therapy and in the more severe cases, surgery.

Please visit our website for a more information regarding Erb’s Palsy including:

History

Treatment

Risk Factors

Types of Medical Malpractice Cases

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