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As clinical negligence lawyers representing children who have suffered Erb’s Palsy during their birth, I and my colleagues take great interest in any treatment which can assist those with Erb’s Palsy. In this blog I consider the role of surgery for children with Erb’s palsy.
Erb’s palsy is a condition in which one or more of the nerves in the brachial plexus are damaged. These nerves run down from the neck on both sides, immediately behind the collar bones, and into each arm. If these nerves are damaged, then the degree of movement and power in the affected arm is diminished. Often, Erb’s palsy is associated with trauma during labour, which may have a variety of causes including forceful tugs upon the baby’s head by medical staff in circumstances where the baby may have become stuck due to shoulder dystocia, which we have written about before.
Surgery for Erb’s palsy is a relatively common treatment option, and may alleviate the degree of damage done to the nerves, and many of our clients with Erb’s Palsy have benefitted from such surgery.
Typically, doctors caring for newborn children who have suffered a brachial plexus injury may wish to ‘wait and see’ what happens for a few months. This is to see whether the nerve injury will remit spontaneously.
If there is no improvement, then exploratory surgery on the affected nerves might be discussed with the child’s parents. This operation is normally performed by a plastic surgeon. Like any procedure that involves a child, it requires parental consent to go ahead. The surgical team would generally set out the risks and benefits of the operation before answering any questions.
In such a surgical procedure, the operator will initially inspect of the area and assess any damage found. The surgeon might attempt a nerve grafting procedure. Grafting of this sort tries to produce nerve regeneration, and thus improve the degree of movement and power in the affected arm. Sadly, surgery of this type rarely leads to entirely normal function, and its results will not be immediately apparent. This is because nerves recover from injury extremely slowly.
There may be a requirement for further surgery at a later date, depending on the severity of the injury. These operations will aim to improve function. Some patients may require further surgery, either in late adolescence or in adult life.
In part because further surgery remains a possibility, it can be quite difficult to predict the outcome for a child who suffers from Erb’s until some years after their birth and frequently not until they reach skeletal maturity (this occurs in adolescence).
Whilst surgery can be very beneficial and may alleviate some problems in children with Erb’s palsy, it will not fully cure the condition, and those with Erb’s Palsy will usually require additional support and have additional needs throughout their life. Assessing a child’s future care requirements is not straightforward whilst the child is growing up. This is because, as children grow up, parents will meet the majority of those care needs, and the child may not realise the level of input they need until they reach an age of becoming more independent.
Moreover, the impact of disabilities on a child’s ability to function at work and socially is not always clear-cut. A very academically bright child might experience fewer Erb’s-related problems in the workplace than a sufferer who would have preferred to work in a manual occupation. This is because, whilst it may be quite possible for people with Erb’s Palsy to work in a manual occupation, they will have only one ‘good’ arm and this has be linked in some cases to early retirement. In addition, were the good arm to deteriorate for any reason (e.g., carpal tunnel syndrome, tennis elbow or frozen shoulder), then there would be no way in which they could compensate for that using the other arm. Equally, if there was a family tendency to painful conditions such as arthritis or hypermobility syndrome, that could interact with Erb’s palsy to produce more difficulties over time. There is the further consideration that just using one arm throughout a person’s lifetime will inevitably place more strain on it than would otherwise have been the case. The extra wear and tear the condition imposes on the ‘good arm’ can itself predispose sufferers to an early (or earlier) onset of problems in this limb.