United Brachial Plexus Network, Inc.

Can anyone out there help me? Excessive lateral traction was applied to my child's head during delivery and no manuvers were performed, however, my child's BPI injury (unlike many) involved the posterior arm. This complicates having a case because most of the literature supports SD & BPI's involving the anterior arm.

Does anyone out there know of any research/literature that supports injuries with the posterior shoulder? Does anyone know anyone who has won a case with this type of injury or how I could get in touch with them?

With what went on in that delivery room, my child is lucky that a bilateral injury was not sustained. I would hate to think I don't have a case.

Thank you

I know someone who won a posterior shoulder trial. I will email her and ask her if she can respond to your post.

Recently several of our group members have had their cases closed because of the posterior arm being injured rather than the anterior arm.
In a recent edition of a publication called Clinical Risk, November 2002 volume 8 number 6 an article entitled
"Mechanisms of obstetric brachial plexus palsy: a critical analysis" by Professor Ron Taylor and Gordon Stirrat(p 218-222)

The authors state
"Damage to the plexus of the posterior shoulder can occur and is associated with pressure on the sacral promontory. this is not due to any action of the accoucheur and is, therefore, not negligent by definition."

In these cases the claim has not been allowed to proceed to the court stage and the claimants have lost their case.

Dear Guest,
I think I am the person Francine is referring to. Feel free to email and I will help you in any way I can. It may take me a while to dig out my trial stuff, but I will certainly help if I can.
Beth

Okay, this may sound stupid, but how do I know...or how can I figure out, what arm was injured on Ella?
Posterior or anterior?
Thanks.
Krista

O.K this is painful but when my child was injured I could see thew midwife pulling to the right and to the left and up and down! When a baby gets stuck and a health professional panics they pull every which way!!! It is a horrible thing.
T.

I have a child with posterior shoulder dislocation and winging of the scapula. but not from birth injury. I am curious how your childrens dr. dealt with this. did they have surgery? I do know that posterior is most rare form of dislocation. Any information you can share would be great.

I do have some cases that involve injury to the posterior shoulder. In some instances the question of posterior versus anterior shoulder injury is not relevant because there should not haved been a vaginal delivery at all. There are several basis for a brachial plexus case. Briefly, was the fetus macrosomic with, or without, a diabetic mother. Was there a meaningful assesment of the fetal weight. Further, if there was an attempt at vaginal delivery, was there a prolonged second stage of labor . Was a vaccuum extraction done, were forceps used at an improper station. All of these factors, and so many many more that I have not mentioned, go into the analysis of a brachial plexus case, and none of these issues concern the anterior or posterior shoulder.

The question of anterior or posterior shoulder only arises in cases where the only issue is excessive traction at delivery, without any warning factors, and assuming that all of the standard maneuvers were performed such as McRoberts and Woods. In fact those cases are the most difficult to win whether the anterior or posterior shoulder is involved.

I did previously post some references to posterior shoulder injury and will do so again. If anyone has any particular questions, please feel free to contact me directly.

Ken Levine
BRL77@world.std.com
617-566-2700


Reply: Severe brachial plexus injury in the posterior arm: An
alternative explanation
Jennett - Am J Obstet Gynecol - 2002 Jun; 186(6); 1378
Severe brachial plexus injury in the posterior arm: An alternative
explanation.
Allen RH - Am J Obstet Gynecol - 01-Jun-2002; 186(6): 1377-8;
discussion 1378

Disuse osteoporosis as evidence of brachial plexus palsy due to
intrauterine fetal maladaptation.
Jennett RJ - Am J Obstet Gynecol - 01-Jul-2001; 185(1): 236-7

Reply
Gherman - Am J Obstet Gynecol - 1999 May; 180(5); 1312

Erb's palsy contrasted with Klumpke's and total palsy: different
mechanisms are involved.
Jennett RJ - Am J Obstet Gynecol - 01-Jun-2002; 186(6): 1216-9;
discussion 1219-20
Principles and practice of management of shoulder dystocia
Bower DJ - Clin Fam Pract - 2001 Jun; 3(2); 401-427
Shoulder dystocia: an obstetric emergency.
Bennett BB - Obstet Gynecol Clin North Am - 01-Sep-1999; 26(3):
445-58, viii

Shoulder dystocia.
Wagner RK - Obstet Gynecol Clin North Am - 01-Jun-1999; 26(2):
371-83

Brachial plexus palsy: an in utero injury?
Gherman RB - Am J Obstet Gynecol - 01-May-1999; 180(5): 1303-7
Electrodiagnostic approach to the patient with suspected
mononeuropathy of the upper extremity
Herrmann D - Neurol Clin - 2002 May; 20(2); 451
Correlation of head-to-body delivery intervals in shoulder
dystocia and umbilical artery acidosis
Stallings SP - Am J Obstet Gynecol - 2001 Aug; 185(2); 268-274

Postinjury neuropathic pain syndromes.
Schwartzman RJ - Med Clin North Am - 01-May-1999; 83(3): 597-626
Erb's palsy causation: a historical perspective.
Sandmire HF - Birth - 01-Mar-2002; 29(1): 52-4
[Shoulder dystocia--consequences and procedures]
Dudenhausen JW - Zentralbl Gynakol - 01-Jul-2001; 123(7): 369-74