FAQs

The answer to this question is directly related to the extent of the injury, how many nerves are affected, and to what extent -- a stretch, tear or complete avulsion.

If there is complete recovery, for all intents and purposes there will be no noticeable limitations in the activities of daily living. For those where recovery is incomplete there will be limitations in movement. This kinematic study shows the limitations of certain movements of a small group of OBPI patients versus a "normal" group. Obviously some of these standard limitations have shown to be improved with certain surgical interventions and/or non-invasive intervention such as therapy and splinting. Again it should be noted that these limitations and how they affect the patient are individual, based on both the injury and also the perception of the patient or caretaker. What one person would view as a limitation that should be corrected/treated another may see as no big deal.

The basic answer is that if a qualifed ob/gyn reviews your medical records and finds that the doctor that delivered your child fell below the standard of care, was negligent, then you do have a good case. Of course as we all know, even good cases, with strong support from medical experts sometimes lose at trial.

The complex answer is that brachial plexus cases come in many different styles. I will try to generally explain:

  1. Pre-natal cases: With women diagnosed with gestational diabetes the physician must be concerned about fetal macrosomia (large baby). It is accepted that babies of gestational diabetic mothers are at greater risk for macrosomia, and in turn shoulder dystocia. When reviewing a case, we look to see if in the pre-natal period were there warning signs that should have alerted the ob/gyn that there was a greater risk of shoulder dystocia. In these cases, our position is that the risks should have been explained to the mother and a cesearian section offered. Other pre-natal risk factors that are important include obesity, prior shoulder dystocia, history of traumatic birth.
  2. Labor cases: In some instances, there is no indication of gestational diabetes, or fetal macrosomia during the pre natal period, yet during the labor process, there are indications of impending shoulder dystocia. For example, labor is usually seperated into three stages. The first stage is early labor, the second stage begins when the mother starts to push and the third stage is at the actual time of delivery. Depending on some other factors such as how many prior deliveries the mother has had, the second stage of labor should last no more than 2 hours. If it is longer, it may be abrupted labor. Slowed labor can be a sign of impending shoulder dystocia, The labor is slowed because the baby is too big to descend properly. The real problems come though with the use of a vacuum or forceps with a baby with slowed labor that has not properly descended. The FDA has reported increased incidence if injury to the baby when a vacuum is used in the face of shoulder dystocia. Although it is a complex medical issue, if the baby has not properly descended, the doctor should not panic. If the baby's fetal heart monitor is fine, the ob/gyn should leave the baby alone. If it descends, that is fine. If not, a cesearian section can be performed. Using a vacuum or forceps to force a baby with shoulder dystocia down is not correct, and can cause serious injury to the baby.
  3. Delivery cases: The third type of case occurs at delivery. In these cases the progress of labor was normal, there is no diagnosis of gestational diabetes and the baby may or may not be macrosomic. In these instances, the shoulder dystocia is first recognized at the time of delivery. Usually when the baby's head shows and then pops back in. This is know as the "turtle sign". At that point the ob/gyn must not panic. If not already done, an episiotomy should be performed, followed by the standard maneuvers to deal with should dystocia-McRoberts manuever, Woods maneuver and suprapubic pressure. If these manueuvers are not done, or if excessive traction is applied to the baby's head during the delivery, it can be the basis of a malpractice case.

 

These are general descriptions. Before any lawyer can advise you about your case the complete medical records must be reviewed, medical research done, and the lawyer should consult with a qualified medical expert.

(UBPN thanks Ken Levine for contributing this answer.)

There are no long term studies explaining the impact on the unaffected arm that we are aware of. The unaffected arm supports the majority of life functions and work. The result of a lifetime of compensation can be overuse and many of the problems connected with repetitive stress syndrome. The extent of the initial injury predicts the amount of overuse. Many adults report arthritis, spinal problems and nerve compression on the unaffected side, therefore, it is best not to push one's endurance to the limit. Overwork or heavy lifting can put a strain on the unaffected arm and may cause damage later on in life.

Horner's Syndrome results from damage to the sympathetic nerve system and involves some or all of the following classic clinical findings: a drooping eyelid (ptosis), smaller pupil (miosis), a sunken eyeball (enophthalmos), and lack of or decreased sweating on the affected side of the face (facial anhidrosis). Abnormal tearing can also result from Horner's. There are no complications nor is there any pain associated with Horner's Syndrome but neither is there a cure. It is important to notify hospital staff before any surgical procedure as they may become alarmed at the lack of dilation of one of the pupils if they do not know the cause.

Pain sensations normally come from activity generated in terminals of certain sensory nerves. When these are stimulated, they respond by increasing their rate of activity.  The nervous system then interprets this as pain. If an injured area develops ongoing spontaneous activity the patient suffers “neuropathic pain”.   Neuropathic pain results from injury to the nerve and often persists long after healing. It is commonly described as a burning or stabbing pain, sometimes feeling like lightning.

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