Erb's Palsy and Brachial Plexus Birth Injuries in Michigan: A Parent's Complete Guide
Short answer: Erb's palsy is a brachial plexus injury that occurs when the nerves controlling the shoulder, arm, and hand are stretched or torn during a difficult delivery, typically a shoulder dystocia where the baby's shoulder lodges behind the mother's pubic bone. When the obstetric team responds with excessive downward traction on the baby's head, the brachial plexus nerves can be permanently damaged. Some Erb's palsy cases resolve within months. Others leave the child with lifelong weakness, reduced function, or full paralysis of the affected arm. When the injury was caused by a deviation from the standard obstetric response to shoulder dystocia, Michigan law allows the family to pursue a medical malpractice claim against the responsible providers under MCL § 600.5838a and related statutes.
Last updated 2026-05-18 by Ali H. Koussan, Founding Attorney at Koussan Law. This guide is for parents trying to make sense of a brachial plexus diagnosis and decide whether the injury was preventable.
What Is the Brachial Plexus?
The brachial plexus is a network of nerves originating in the spinal cord at the neck (C5 through T1), running through the shoulder, and branching out to control the muscles of the shoulder, arm, and hand. These nerves carry both motor signals (telling muscles to move) and sensory signals (touch, temperature, pain). When the nerves are damaged, the muscles they control lose function. The pattern of weakness depends on which nerve roots were injured.
- Erb's palsy (Erb-Duchenne palsy): Injury to the upper brachial plexus (C5-C6, sometimes C7). Affects shoulder abduction, elbow flexion, and forearm rotation. The classic "waiter's tip" posture, the arm hanging at the side with the forearm rotated inward.
- Klumpke's palsy: Injury to the lower brachial plexus (C8-T1). Affects the forearm, wrist, and hand muscles. Rarer than Erb's palsy and often more severe.
- Global brachial plexus injury: Damage across the entire plexus (C5-T1). The full arm is paralyzed. The most severe presentation.
The injury can be a stretch injury (neurapraxia, often recovers within weeks to months), a rupture (the nerve is partially or fully torn but still anchored to the spinal cord), or an avulsion (the nerve root is pulled completely out of the spinal cord). Stretch injuries often recover. Avulsions almost never do without surgical reconstruction.
How Brachial Plexus Injuries Happen at Birth
The overwhelming majority of obstetric brachial plexus injuries occur during shoulder dystocia, a delivery emergency where the baby's anterior shoulder lodges behind the mother's pubic bone after the head has delivered. Shoulder dystocia is a recognized obstetric emergency. There is a defined protocol the medical team must follow:
- McRoberts maneuver: hyperflexing the mother's hips toward her abdomen to widen the pelvic outlet. First-line and successful in many cases.
- Suprapubic pressure: applying pressure just above the pubic bone to dislodge the impacted shoulder.
- Internal rotation maneuvers (Rubin, Woods' screw): rotating the baby to disengage the shoulder.
- Delivery of the posterior arm: reaching into the birth canal to deliver the posterior shoulder first.
- Last-resort maneuvers (Gaskin all-fours, Zavanelli, symphysiotomy) when other techniques fail.
What is not part of the protocol, the move that causes most brachial plexus injuries, is excessive downward traction on the baby's head. When a provider pulls too hard or in the wrong direction to free the impacted shoulder, the brachial plexus stretches beyond what the nerves can tolerate. The result is permanent neurological injury.
Other less common causes:
- Improper use of forceps or vacuum extraction
- Breech delivery with mismanaged extraction
- Excessive force in delivering a large or macrosomic baby
Risk Factors That Should Have Been Recognized
Shoulder dystocia is partially predictable. Risk factors recognized in obstetric practice include:
- Estimated fetal weight over 4,000-4,500 grams (macrosomia)
- Maternal diabetes (gestational or pre-existing)
- Maternal obesity
- Prior shoulder dystocia in a previous pregnancy
- Prolonged second stage of labor
- Use of vacuum or forceps assistance
- Post-term pregnancy
When these risk factors are present, the obstetric team should be prepared for shoulder dystocia. In some cases, a planned cesarean delivery is the appropriate response, particularly when the estimated fetal weight is very large or the mother has diabetes plus other risk factors. Failure to recognize and act on these risk factors is one of the most common bases for a birth injury malpractice claim.
Is My Baby's Erb's Palsy a Birth Injury Claim?
Not every brachial plexus injury is the result of medical negligence. Some occur despite the medical team following protocol exactly. Some are caused by maternal forces of labor independent of provider action. The legal question is whether the team's response to shoulder dystocia met or deviated from the obstetric standard of care. Key questions our medical experts examine:
- Were risk factors documented and addressed before delivery?
- Was the shoulder dystocia recognized and announced in real time?
- Were the recommended maneuvers attempted in the recommended order?
- Was excessive downward traction applied?
- Was the duration of the dystocia event consistent with appropriate response, or was the baby's head impacted longer than necessary?
- Did the delivery note accurately document the maneuvers used and their timing?
A board-certified obstetrician reviews the labor and delivery records, the fetal monitoring strips, the nursing notes, and the delivery note to determine whether the standard of care was met. This is the single most important step in evaluating a brachial plexus claim. We do not file these cases without expert support.
What Recovery Looks Like
The prognosis depends on the severity of the nerve injury. Some patterns we see clinically:
- Mild stretch injuries (neurapraxia): Many resolve within 3-6 months with physical therapy. Some children regain full function by age 1-2 with no residual deficit.
- Moderate injuries (axonotmesis): Partial recovery is typical. Surgical intervention (nerve grafts, nerve transfers) may be recommended between 3-9 months of age if recovery has stalled.
- Severe injuries (neurotmesis, avulsion): Permanent dysfunction is likely. Surgical reconstruction, tendon transfers, and multiple secondary procedures over the child's lifetime are common.
The window for the most effective surgical intervention is narrow. Brachial plexus surgery (when indicated) is typically most successful when performed between 3 and 9 months of age. Delay past 12 months substantially reduces the likelihood of meaningful recovery. This is one reason why early evaluation by a pediatric brachial plexus specialist is essential.
How Michigan Law Treats Brachial Plexus Birth Injury Claims
Erb's palsy and brachial plexus claims fall under Michigan's medical malpractice framework. The procedural requirements include:
- Pre-suit Notice of Intent served on each provider, with a 182-day waiting period (MCL § 600.2912b).
- Affidavit of Merit from a qualified expert (typically a board-certified obstetrician) filed with the complaint (MCL § 600.2912d).
- Damages cap on non-economic damages under MCL § 600.1483. The cap is adjusted annually for inflation, with a higher tier for catastrophic injuries (loss of bodily function, paralysis) that brachial plexus cases often satisfy. Economic damages, future medical care, lost earning capacity, are not capped.
- Filing deadline for minors is extended under MCL § 600.5851, but the extensions are narrower than parents expect. Birth-related medical malpractice claims involving children under 8 have specific outer-limit caps. Do not assume you have until your child's 18th birthday to file. Consult counsel within the first 2-3 years of the diagnosis.
For a comprehensive walkthrough of Michigan personal injury filing deadlines, see our Michigan Personal Injury Statute of Limitations guide. For the broader framework on birth injury cases, see our Cerebral Palsy Birth Injury Claims guide.
Damages in Erb's Palsy Cases
Settlement and verdict ranges depend on injury severity:
- Mild residual deficit, full functional recovery: $50,000-$250,000 range.
- Moderate permanent dysfunction, some surgical intervention: $250,000-$1,500,000 range.
- Severe permanent injury, multiple surgeries, lifelong functional limitation: $1,500,000-$5,000,000+ range.
- Global brachial plexus avulsion with permanent paralysis: $3,000,000-$10,000,000+ range. Lifetime care, multiple reconstructive surgeries, and lost earning capacity drive the upper end.
Koussan Law has secured a $14.95 million jury verdict against Pontiac General Hospital in a sexual assault and institutional negligence case. That experience informs how we approach every brachial plexus case, particularly the documentation of lifetime care needs and lost earning capacity. For more on how case values are constructed in Michigan, see our Michigan personal injury case value guide.
What Parents Should Do
- Get a pediatric brachial plexus specialist evaluation within the first 3-6 months. Time-sensitive surgical decisions depend on early imaging and neurological assessment. Major Michigan children's hospitals have dedicated brachial plexus programs.
- Request the complete labor and delivery record. The delivery note, the fetal monitoring strips, the nursing notes, the operative report (if applicable), and the discharge summary. Hospitals must produce these on request.
- Document your child's deficits. Photographs and video of the affected arm over time. Therapy progress notes. IEP and early-intervention records. These build the damages case.
- Do not accept early settlement offers from the hospital risk management department. They are almost always far below what the case is worth, particularly for permanent injuries where future medical needs cannot yet be fully projected.
- Consult a Michigan birth injury attorney within 2-3 years of the diagnosis. Earlier is better. The medical malpractice procedural requirements (Notice of Intent, Affidavit of Merit) take time to satisfy.
Frequently Asked Questions About Michigan Erb's Palsy Claims
What causes Erb's palsy?
Erb's palsy is caused by injury to the upper brachial plexus nerves (C5-C6, sometimes C7) during delivery. The most common mechanism is excessive downward traction applied to the baby's head during a shoulder dystocia. Other causes include improper use of forceps or vacuum extraction, breech delivery complications, and difficult delivery of a large baby.
Is Erb's palsy permanent?
It depends on the severity of the nerve injury. Mild stretch injuries (neurapraxia) often resolve completely within 3-6 months. Moderate injuries may leave residual weakness despite recovery. Severe injuries (rupture or avulsion) typically result in permanent dysfunction without surgical intervention, and even then full recovery is uncommon. Approximately 20-30 percent of brachial plexus birth injuries result in some permanent deficit.
What is the difference between Erb's palsy and cerebral palsy?
Erb's palsy is a peripheral nerve injury affecting one arm (the brachial plexus is outside the brain and spinal cord). Cerebral palsy is a brain injury causing motor and developmental disability affecting multiple body parts. Erb's palsy typically does not affect cognition; cerebral palsy often does. They have different causes, different prognoses, and are evaluated differently in medical malpractice claims.
How do I know if my baby's Erb's palsy was caused by medical negligence?
The legal standard is whether the obstetric team's response to shoulder dystocia (or other delivery complication) deviated from the medical standard of care. Key indicators of possible negligence: documented risk factors that were ignored, failure to perform recommended maneuvers in the correct order, evidence of excessive downward traction, inadequate documentation of the delivery, and disagreement between the delivery note and the nursing notes. A board-certified obstetrician must review the records to make this determination.
What is the statute of limitations for an Erb's palsy claim in Michigan?
Medical malpractice claims in Michigan generally must be filed within two years of the malpractice, or six months from discovery, whichever is later, with a six-year outer limit (MCL § 600.5838a). Claims involving minors get extended deadlines under MCL § 600.5851, but the extensions are narrower than most parents expect, particularly for births involving children under age 8. Consult counsel early.
Is Erb's palsy considered a serious birth injury?
Yes. Even mild brachial plexus injuries that fully resolve require months of therapy and pediatric specialist evaluation. Moderate-to-severe cases involve permanent limitations, multiple surgeries over a lifetime, lost earning capacity, and significant emotional and developmental impact. Michigan's medical malpractice damages cap recognizes brachial plexus injuries as catastrophic when the dysfunction is permanent.
What surgical options exist for Erb's palsy?
Primary nerve surgery (nerve grafting or nerve transfer) is typically considered between 3 and 9 months of age if natural recovery has stalled. Later in childhood, secondary procedures like tendon transfers, capsular releases, and humeral osteotomy can improve function. Each surgical decision is made by a pediatric brachial plexus specialist based on the specific pattern of injury and functional deficit.
How much does an Erb's palsy lawsuit settle for?
Settlement ranges vary widely based on injury severity, evidence of negligence, and the strength of the damages case. Mild cases with documented negligence may settle in the low six figures. Permanent injuries with documented negligence routinely settle in the high six and low seven figures. Severe global plexus injuries can reach $5,000,000-$10,000,000+ when liability is clear and damages are well-documented.
Does Michigan cap damages in Erb's palsy cases?
Michigan caps non-economic damages in medical malpractice cases under MCL § 600.1483, adjusted annually for inflation. A higher cap tier applies to catastrophic injuries including paralysis and loss of bodily function. Most permanent brachial plexus cases qualify for the higher tier. Economic damages, future medical care, lost earning capacity, are not capped.
Should I get a second opinion on my baby's diagnosis?
Yes. Brachial plexus injuries require specialized evaluation. Major Michigan children's hospitals (DMC Children's Hospital of Michigan, C.S. Mott Children's Hospital, Helen DeVos Children's Hospital) have pediatric brachial plexus programs. A specialist evaluation is essential both for medical decision-making and for documenting the injury for any potential legal claim.
What evidence is critical in a brachial plexus lawsuit?
The labor and delivery record, particularly the delivery note and any operative reports. Fetal heart rate strips. Nursing notes (which often contradict the delivery note). Prenatal records documenting risk factors. Newborn examination records. Subsequent specialist evaluations and imaging (MRI, EMG). Photographs and video of the affected arm over time. Therapy progress notes. Expert opinions from a board-certified obstetrician (standard of care) and pediatric neurologist or brachial plexus specialist (causation and prognosis).
How Koussan Law Handles Brachial Plexus Cases
We accept Michigan brachial plexus birth injury cases on contingency. You pay nothing unless we recover. We front the cost of medical records retrieval, expert reviews, imaging analysis, life-care planning, and litigation. Our trial experience includes a $14.95 million jury verdict against Pontiac General Hospital in a sexual assault and institutional negligence case. The discipline that produces those results applies to every birth injury case we accept.
If your child was diagnosed with Erb's palsy or another brachial plexus injury and you suspect the delivery was mismanaged, call (313) 800-0000, request a free consultation, or use our free case calculator. We will review the records and tell you, honestly, whether we believe the standard of care was breached.
