Pittsburgh Brachial Plexus Birth Injury Lawyer

When an obstetrician or delivery room nurse uses excessive force during a difficult delivery, the network of nerves connecting a newborn’s spine to their shoulder, arm, and hand can be stretched, torn, or severed permanently. This nerve damage—known as a brachial plexus injury or Erb’s palsy—can leave a child with lifelong paralysis, loss of sensation, and inability to use their arm. John A. Caputo & Associates, P.C. represents families throughout Pittsburgh and Pennsylvania whose children suffered preventable brachial plexus injuries during labor and delivery.

Brachial plexus injuries almost always result from one specific obstetric emergency: shoulder dystocia. When a baby’s shoulder becomes stuck behind the mother’s pubic bone during delivery, medical staff must follow strict protocols to free the baby without damaging the nerves. When obstetricians panic, pull too hard, or use improper maneuvers, the brachial plexus nerves stretch or tear. These injuries are preventable. Elizabeth L. Jenkins and John Caputo have worked exclusively on medical malpractice cases for many years and know how to prove when negligent delivery techniques caused permanent nerve damage.

What Is the Brachial Plexus and How Does Injury Occur During Birth?

The brachial plexus is a network of five nerves that run from the spinal cord through the neck and into the shoulder, arm, and hand. These nerves control all movement and sensation in the upper extremity. During difficult deliveries—particularly when shoulder dystocia occurs—excessive pulling or lateral traction on the baby’s head and neck can stretch, tear, or completely sever these nerves, causing permanent paralysis or loss of function.

The brachial plexus is located roughly between the chest and shoulder blade. It sends signals from the spine to control:

• Shoulder movement and rotation
• Elbow flexion and extension
• Wrist and hand movement
• Finger movement and grip strength
• Sensation in the arm, hand, and fingers

When these nerves are injured during delivery, the damage can range from mild stretching that heals on its own to complete tearing that requires surgical repair—or that may never heal at all.

Brachial plexus injuries during birth typically occur when:

• The baby’s shoulder becomes stuck behind the mother’s pubic bone (shoulder dystocia)
• Medical staff pull on the baby’s head to try to free the shoulder
• Excessive lateral traction stretches the neck, damaging the nerves
• The delivery team fails to follow proper shoulder dystocia maneuvers
• Forceps or vacuum extractors are used improperly

The critical question in brachial plexus injury cases is whether the obstetrician followed accepted protocols or whether negligent delivery techniques caused the nerve damage.

What Is Shoulder Dystocia and Why Does It Cause Brachial Plexus Injuries?

Shoulder dystocia occurs when a baby’s shoulder becomes stuck behind the mother’s pubic bone after the head has been delivered. This is an obstetric emergency requiring immediate, specific maneuvers to free the baby without causing nerve damage. When obstetricians respond by pulling on the baby’s head or using excessive force, the brachial plexus nerves stretch or tear. Proper technique prevents most brachial plexus injuries.

Shoulder dystocia is one of the most dangerous complications in childbirth. Once the baby’s head is delivered, the shoulders must pass through the birth canal. When one shoulder—usually the anterior shoulder—gets stuck, the baby cannot be delivered and time becomes critical. The umbilical cord is compressed, oxygen flow is reduced, and both the baby and mother are at risk.

The medical standard of care for shoulder dystocia is well-established. Obstetricians are trained to:

• Call for help immediately: Shoulder dystocia requires additional staff including anesthesiologists and neonatal specialists
• Use the McRoberts maneuver: Hyperflexing the mother’s legs toward her abdomen to widen the pelvis
• Apply suprapubic pressure: Pressure above the pubic bone to dislodge the stuck shoulder
• Attempt internal maneuvers: Reaching inside to rotate the baby’s shoulders or deliver the posterior arm first
• Avoid excessive traction: Applying force to the baby’s head stretches the brachial plexus nerves

What obstetricians should not do is panic and pull. Brachial plexus injuries occur when delivery teams abandon proper protocols and resort to brute force to free the baby. That’s negligence.

Risk factors for shoulder dystocia that obstetricians should identify during prenatal care include:

• Maternal diabetes or gestational diabetes leading to larger babies (macrosomia)
• Maternal obesity
• Previous deliveries complicated by shoulder dystocia
• Prolonged labor or arrested descent
• Cephalopelvic disproportion – baby too large for the canal

When obstetricians know these risk factors exist, they should plan accordingly—including discussing elective C-section as an option to avoid shoulder dystocia entirely.

What Are the Different Types and Severities of Brachial Plexus Injuries?

Brachial plexus injuries range from mild nerve stretching that heals within months to complete nerve rupture or avulsion requiring surgery. Erb’s palsy affects the upper nerves controlling the shoulder and elbow. Klumpke’s palsy affects the lower nerves controlling the hand and fingers. Total brachial plexus palsy affects all five nerves, causing complete paralysis of the arm. The severity determines whether the child will recover function or face permanent disability.

Brachial plexus injuries are classified by both location and severity:

Types by Location

• Erb’s palsy (upper brachial plexus injury): Damage to the C5 and C6 nerve roots affecting the shoulder, elbow, and upper arm. The child may have limited shoulder movement, weak elbow flexion, and the classic ‘waiter’s tip’ position where the arm hangs limp with the palm facing backward
• Klumpke’s palsy (lower brachial plexus injury): Damage to the C8 and T1 nerve roots affecting the hand and fingers. The child has weak grip, limited finger movement, and may develop a claw-like hand position
• Total brachial plexus palsy: Damage to all five nerve roots (C5-T1) causing complete paralysis of the arm from shoulder to fingertips

Types by Severity

• Neurapraxia (mild stretching): The nerve is stretched but not torn. This is the mildest form and typically heals on its own within three to six months
• Neuroma (scar tissue formation): The nerve heals but forms scar tissue that partially blocks signals. Function may improve with therapy but is often incomplete
• Rupture (nerve torn apart): The nerve is completely torn but remains within the nerve sheath. This requires surgical repair
• Avulsion (nerve torn from spinal cord): The most severe injury where the nerve is torn completely away from the spinal cord. This is often permanent and may not be surgically repairable

The prognosis depends entirely on severity. Mild stretching injuries heal with time and therapy. Ruptures and avulsions often result in permanent loss of function, requiring lifelong accommodations and multiple surgeries.

How Are Brachial Plexus Injuries Diagnosed and Treated?

Brachial plexus injuries are diagnosed through physical examination, nerve conduction studies, electromyography (EMG), and imaging studies including MRI. Treatment depends on severity and ranges from physical therapy for mild injuries to nerve grafting surgery for severe ruptures or avulsions. Early intervention within the first few months is critical to maximize recovery. Many children require occupational therapy for years and multiple surgeries to improve function.

Diagnosis typically begins in the delivery room or shortly after birth. Warning signs that a brachial plexus injury may have occurred include:

The baby’s arm hangs limp and does not move during crying or when startled
Weak or absent Moro reflex (startle reflex) on one side
Asymmetric movement between the two arms
Decreased grip strength in one hand

Diagnostic tests used to assess the severity and location of nerve damage include:

• Physical examination: Testing range of motion, strength, and reflexes
• Nerve conduction studies: Measuring electrical signals in the nerves
• Electromyography (EMG): Assessing muscle response to nerve signals
• MRI: Imaging the nerves and spinal cord to identify tears or avulsions

Treatment Options

Treatment depends on the severity of the injury:

• Physical and occupational therapy: For mild injuries, daily range-of-motion exercises prevent joint stiffness and encourage nerve healing
• Nerve grafting surgery: For severe ruptures, surgeons may graft healthy nerves from other parts of the body to bridge the gap
• Nerve transfer surgery: Redirecting functioning nerves to take over for damaged ones
• Muscle transfer surgery: Moving functioning muscles to restore movement in paralyzed areas
• Tendon release surgery: Releasing contracted tendons to improve range of motion

Even with treatment, many children with severe brachial plexus injuries face permanent limitations. They may never regain full use of the arm, may require multiple surgeries throughout childhood, and often need ongoing therapy and adaptive equipment.

How Do You Prove That Medical Negligence Caused a Brachial Plexus Injury?

Proving medical negligence in brachial plexus cases requires showing that the obstetrician failed to follow accepted shoulder dystocia protocols. Evidence includes delivery room notes documenting the maneuvers used, fetal monitoring strips showing how long the shoulder was stuck, witness testimony from nurses and staff, and expert testimony from obstetricians explaining how proper technique would have prevented the injury. Medical records often reveal excessive traction, improper maneuvers, or failures to call for help.

Not all brachial plexus injuries are preventable, and not all result from negligence. But when an obstetrician fails to follow established protocols for managing shoulder dystocia, the resulting nerve damage is actionable.

Evidence that proves negligence includes:

• Delivery room records: Documentation showing which maneuvers were attempted, in what order, and how long the shoulder was impacted
• Nursing notes: Nurses often record details about excessive pulling, panic, or deviations from protocol
• Fetal monitoring strips: Showing whether the medical team recognized risk factors for shoulder dystocia before delivery began
• Prenatal records: Evidence that the mother had risk factors (diabetes, large baby, previous shoulder dystocia) that should have been planned for
• Expert testimony: Obstetricians explaining what the standard of care required and how the defendant deviated from it

Our attorneys work with obstetric experts who specialize in shoulder dystocia and brachial plexus injuries. These experts review the delivery records, compare the actions taken against accepted protocols, and testify that proper technique would have prevented the nerve damage.

What Compensation Can Families Recover in Brachial Plexus Injury Cases?

Pennsylvania allows full recovery of economic and non-economic damages with no caps. Economic damages include past and future medical expenses, surgeries, therapy, adaptive equipment, and loss of future earning capacity if the injury is permanent. Non-economic damages cover pain, suffering, and loss of normal childhood activities. Because brachial plexus injuries often require lifelong treatment and multiple surgeries, settlements and verdicts can reach into the millions.

The lifetime cost of caring for a child with a permanent brachial plexus injury includes:

• Years of physical and occupational therapy
• Multiple reconstructive surgeries during childhood and adolescence
• Adaptive equipment and assistive devices
• Educational accommodations and tutoring
• Loss of future earning capacity if the child cannot work in careers requiring full arm function
• Pain and suffering from permanent disability

Our attorneys work with life care planners and forensic economists to calculate these costs over the child’s lifetime. We make sure every category of future expense is documented before any settlement is discussed.

Contact Our Experienced Pittsburgh Brachial Plexus Birth Injury Lawyers

If your child was diagnosed with Erb’s palsy, brachial plexus injury, or arm paralysis after a difficult delivery involving shoulder dystocia, contact John A. Caputo & Associates, P.C. for a free consultation. We represent families throughout Pittsburgh, Allegheny County, and Western Pennsylvania in birth injury cases.

Call 412-391-4990 or contact us online to discuss your case. We’ll review your child’s medical records, explain your legal options, and help you understand whether medical negligence caused your child’s injury.

Frequently Asked Questions

Can brachial plexus injuries heal on their own?

Mild brachial plexus injuries caused by nerve stretching (neurapraxia) often heal on their own within three to six months with physical therapy. However, more severe injuries including nerve ruptures and avulsions do not heal without surgical intervention. The first three months are critical—if the baby is not showing improvement by that time, the injury is likely severe and may require surgery. Early evaluation by a pediatric neurologist or brachial plexus specialist is essential.

What is the difference between Erb’s palsy and Klumpke’s palsy?

Erb’s palsy affects the upper brachial plexus nerves (C5-C6) controlling the shoulder, elbow, and upper arm. Children with Erb’s palsy have weak shoulder movement, limited elbow flexion, and the classic ‘waiter’s tip’ arm position. Klumpke’s palsy affects the lower brachial plexus nerves (C8-T1) controlling the hand and fingers, causing weak grip and claw-like hand deformity. Erb’s palsy is far more common, accounting for the majority of brachial plexus birth injuries.

What surgical options exist for severe brachial plexus injuries?

Surgical options include nerve grafting (using healthy nerves from elsewhere in the body to bridge torn nerves), nerve transfer (redirecting functioning nerves to take over for damaged ones), muscle transfer (moving functioning muscles to restore movement), and tendon release surgery (releasing contracted tendons to improve range of motion). Surgery is typically performed between 3 and 9 months of age if the child is not showing improvement. Multiple surgeries may be needed throughout childhood as the child grows.

Are all brachial plexus injuries caused by medical negligence?

No. Some brachial plexus injuries occur despite proper technique, particularly when shoulder dystocia is severe and unavoidable. However, when obstetricians fail to follow established protocols for managing shoulder dystocia—including calling for help, using appropriate maneuvers, and avoiding excessive traction on the baby’s head—the resulting nerve damage is often preventable and constitutes negligence. An experienced attorney can review the delivery records and determine whether the standard of care was met.

How long do I have to file a brachial plexus injury claim in Pennsylvania?

Pennsylvania gives families extended time to file birth injury claims. The statute of limitations does not begin until the child turns 18, meaning parents can file until the child’s 20th birthday. However, waiting too long makes evidence harder to gather and cases harder to prove. Medical records become difficult to obtain, witnesses forget details, and hospitals are less willing to settle old claims. Early consultation with an attorney protects your family’s rights and preserves critical evidence.

What is shoulder dystocia and how often does it occur?

Shoulder dystocia occurs when a baby’s shoulder becomes stuck behind the mother’s pubic bone after the head has been delivered. It complicates approximately 0.5% to 3% of all vaginal deliveries. While shoulder dystocia itself is not always preventable, obstetricians are trained to manage it using specific maneuvers that minimize the risk of brachial plexus injury.

Will my child’s arm function improve with therapy?

The prognosis depends entirely on the severity of the nerve damage. Children with mild stretching injuries often recover fully with consistent physical and occupational therapy. Those with more severe injuries may regain partial function but face permanent limitations. Early intervention is critical—starting therapy within the first few weeks of life gives the child the best chance of recovery. A pediatric brachial plexus specialist can assess the injury and provide a realistic prognosis.

How much does it cost to hire a brachial plexus birth injury attorney?

Our firm works on a contingency fee basis. There are no upfront costs and no legal fees unless we recover compensation for your family. We advance all litigation costs including expert witness fees, medical record retrieval, and depositions. If we don’t win, you owe us nothing. The contingency fee is discussed and agreed upon before we begin work on your case.