What is Erb’s Palsy?
Erb’s palsy, also known as Erb-Duchenne palsy, is a condition caused by injury to the brachial plexus, a network of nerves that runs from the spinal cord through the neck and into the arm.
These nerves control movement and sensation in the shoulder, elbow, wrist, and hand.
When these nerves are stretched, compressed, or torn during delivery, the result can be partial or complete paralysis of the affected arm.
The severity of Erb’s palsy depends on the nature and extent of the nerve injury.
Mild cases involving nerve stretching (neuropraxia) may resolve within weeks to months.
More serious injuries, involving partial or complete tearing of the nerves, may result in permanent impairment. In the most severe cases, surgery, including nerve grafting or tendon transfer procedures, may be required.
Erb’s palsy affects approximately one to two in every 1,000 babies born in Ireland and the United Kingdom.
It occurs most commonly in association with shoulder dystocia, a delivery complication in which the baby’s shoulder becomes lodged behind the mother’s pelvic bone after the head has been delivered.
Can Erb’s Palsy be caused by medical negligence?
Not every case of Erb’s palsy arises from negligence. Some degree of force is inherent in the management of shoulder dystocia, and the condition can occur even where the correct standard of care was observed.
However, where the force applied was excessive, where the complication was not recognised in a timely manner, or where established protocols for managing shoulder dystocia were not followed, there may be grounds for a medical negligence claim.
To establish negligence, it is necessary to demonstrate that the standard of care provided fell below that which a reasonably competent medical professional in the same speciality would have provided in the same circumstances.
This standard, as applied in Ireland, derives from the Supreme Court decision in Dunne v National Maternity Hospital [1989] IR 91.
Expert medical evidence is essential to establishing whether the standard was breached and whether that breach caused the injury.
Claims are governed by the Civil Liability Act 1961 and the Statute of Limitations Act 1957, as amended by the Statute of Limitations (Amendment) Act 1991.
Common causes of Erb’s Palsy at birth
The following circumstances may give rise to a brachial plexus injury at birth and may, depending on the clinical context, indicate a breach of the required standard of care:
- Failure to anticipate or recognise the risk of shoulder dystocia in advance of delivery
- Failure to identify risk factors for shoulder dystocia, including macrosomia (large baby), maternal diabetes, prolonged labour, or prior history of shoulder dystocia
- Application of excessive lateral traction to the baby’s head or neck during delivery
- Failure to apply established manoeuvres for the management of shoulder dystocia, such as the McRoberts manoeuvre or suprapubic pressure
- Inappropriate use of fundal pressure, which is contraindicated in shoulder dystocia
- Incorrect or excessive use of forceps or vacuum extraction
- Delay in recognising or responding to signs of foetal distress that required delivery intervention
How is an Erb’s Palsy claim made in Ireland?
A medical negligence claim involving Erb’s palsy is initiated by seeking independent legal advice from a solicitor with experience in birth injury claims. The general process involves the following steps:
- Legal consultation: review of the birth circumstances and advice on the potential merits of a claim
- Request for records: full maternity records, including CTG traces, midwifery notes, labour charts, and neonatal records, are obtained from the treating hospital
- Independent medical review: a medical expert with relevant experience assesses the records and provides a report on liability, causation, and the applicable standard of care
- Letter of Claim: if the expert report supports a finding of negligence, a formal Letter of Claim is issued to the relevant defendant
- Response and negotiation: the defendant responds to the claim; if liability is admitted or a reasonable offer is made, the matter may be resolved without going to court
- Litigation: where the claim cannot be resolved by agreement, court proceedings may be issued
Our solicitors can also advise on birth injury claims in Ireland more broadly, including injuries affecting the child or mother during delivery.
Erb’s palsy claims fall under a broader category of birth injury solicitor services provided by Coleman Legal LLP.
Time limits for Erb’s Palsy claims in Ireland
The standard limitation period for personal injury claims in Ireland is two years from the date of injury or the date of knowledge.
Because Erb’s palsy is a birth injury sustained by a minor, the limitation period is modified by the rules applicable to minors.
Where the injured party is a child, the two-year period generally does not begin to run until the child’s 18th birthday.
The claim must therefore ordinarily be brought before the child turns 20.
However, the date of knowledge provisions may also be relevant, and the applicable limitation period can vary depending on the specific circumstances of the case.
Even if time remains, it is strongly advisable to seek legal advice without delay.
Evidence, including medical records and witness accounts, is easier to gather while the events are more recent. To discuss time limits with our birth injury solicitors, contact Coleman Legal LLP today.
What compensation may cover in an Erb’s Palsy claim?
Compensation in an Erb’s palsy claim is assessed on a case-by-case basis.
An award may include both general damages and special damages.
General damages compensate for the pain, suffering, and reduction in quality of life attributable to the injury, assessed over the child’s lifetime.
Special damages cover financial losses and expenses incurred as a result of the injury, which may include:
- The costs of physiotherapy, occupational therapy, and other rehabilitation services
- Surgical costs, including nerve repair, tendon transfer, or other orthopaedic procedures
- Assistive devices and adapted equipment to support daily living and physical functioning
- Adaptations to the family home to accommodate the child’s needs
- Psychological support for the child and, in appropriate cases, the family
- Future loss of earnings where the child’s working capacity is impaired
- Ongoing care and case management costs
Calculating future losses requires input from actuarial and healthcare experts who assess the child’s long-term needs.
Frequently asked questions
What is the difference between Erb’s Palsy and brachial plexus injury?
Erb’s palsy is a specific type of brachial plexus injury.
The brachial plexus is a network of nerves that runs from the spinal cord through the neck and into the arm.
Erb’s palsy occurs when the upper roots of the brachial plexus (C5 and C6) are damaged, causing weakness or paralysis predominantly in the shoulder and upper arm.
Other forms of brachial plexus injury may affect different nerve roots and result in different patterns of impairment.
Will my child’s Erb’s Palsy improve over time?
This depends on the severity of the nerve injury.
In milder cases involving nerve stretching (neuropraxia), spontaneous recovery is common within the first few months of life.
In more severe cases involving partial or complete nerve tearing, recovery may be incomplete.
Early physiotherapy is generally recommended, and surgical intervention may be considered where progress is insufficient.
How do I know if the Erb’s Palsy was caused by negligence?
An independent medical expert must review the maternity records, including delivery notes, CTG traces, and any documentation relating to the management of shoulder dystocia, in order to form a view on whether the standard of care was met.
This is a fact-specific assessment and cannot be determined without reviewing the clinical records.
Can I claim if the injury occurred in a private hospital?
Yes. Medical negligence claims may be brought against both public and private healthcare providers.
If the birth took place in a private hospital and the injury arose from a breach of the required standard of care, a claim may be made against the relevant clinicians and the hospital.
The applicable procedure may differ from claims involving public hospitals or HSE-employed staff.
What is shoulder dystocia?
Shoulder dystocia is an obstetric emergency in which, after the baby’s head has been delivered, one or both shoulders become lodged behind the mother’s pelvic bone.
It is a recognised risk factor for brachial plexus injury, including Erb’s palsy. Midwives and obstetricians are trained in specific manoeuvres to safely resolve shoulder dystocia.
Where these manoeuvres are not applied correctly, or where excessive force is used, the risk of brachial plexus injury is increased.
What is the role of the State Claims Agency?
The State Claims Agency is the body responsible for managing clinical negligence claims against public health service bodies in Ireland, including HSE hospitals and employed clinicians.
Where a claim is made against a publicly funded healthcare provider, the State Claims Agency typically handles the defence and any settlement negotiations on behalf of the State.
How long will an Erb’s Palsy claim take?
The duration of a claim depends on factors including the complexity of the medical evidence, whether liability is admitted, and the extent of the child’s ongoing care needs.
Cases may take several years to resolve fully, particularly when assessing long-term losses requires input from multiple experts. Early resolution through negotiation is possible in some cases.
Can both parents bring a claim on behalf of their child?
Yes. Either the child’s parent or legal guardian may bring a claim on the child’s behalf. Any settlement agreed on behalf of a minor requires court approval in Ireland.
This process is designed to ensure that the settlement is in the child’s best interests.
What if I am outside the two-year limitation period?
For injuries sustained by a minor, the general two-year limitation period does not run until the child’s 18th birthday, meaning the claim may be brought before the child’s 20th birthday.
Date-of-knowledge provisions may also affect the applicable deadline. If you are concerned about time limits, seek legal advice as soon as possible.
Does Coleman Legal LLP handle Erb’s Palsy claims nationwide?
Yes. Coleman Legal LLP accepts instructions from clients throughout the Republic of Ireland and is not limited to any particular county or region. Initial consultations can be arranged by telephone or remotely where appropriate.
Is there a risk that my child’s records no longer exist?
Healthcare providers in Ireland are required to retain patient records for defined periods in accordance with HSE record retention policies.
Maternity records are typically retained for a minimum period that extends beyond the child’s 18th birthday. If you have concerns about records, your solicitor can make a formal request to the relevant healthcare provider.
Additional resources
For further information on standards in Irish healthcare and regulatory oversight, the following resources may be useful:
- The Health Service Executive (HSE) provides information on maternity services and patient supports.
- The Health Information and Quality Authority (HIQA) is responsible for monitoring and regulating health and social care services in Ireland, including acute hospitals providing maternity services.
