When a newborn has little or no movement in one arm after delivery, parents may hear terms such as brachial plexus birth palsy, neonatal brachial plexus palsy, or Erb’s palsy.

These injuries can occur during difficult births, including deliveries complicated by shoulder dystocia. But the presence of a brachial plexus injury does not automatically mean that a doctor, nurse, or hospital committed malpractice.

Medical literature recognizes several possible mechanisms of neonatal brachial plexus palsy. Some injuries occur in deliveries without clinically recognized shoulder dystocia, and cases have even been reported following cesarean delivery.

For a Kentucky birth injury claim, the important questions are:

• What type and severity of nerve injury occurred?
• What happened during labor and delivery?
• Was shoulder dystocia present?
• How did the medical team respond?
• Were forceps or a vacuum used?
• What does the newborn examination show?
• Did the child recover with therapy or require surgery?
• Does qualified medical review support a preventable departure from appropriate care?

This guide explains those issues, the medical records that may matter, treatment resources in Kentucky, and the Kentucky legal rules that can apply.

What Is the Brachial Plexus?

The brachial plexus is a network of nerves running from the spinal cord through the neck and shoulder into the arm.

Those nerves control movement and sensation in the:

• Shoulder
• Upper arm
• Elbow
• Forearm
• Wrist
• Hand
• Fingers

When these nerves are stretched, damaged, torn, or separated from the spinal cord around the time of birth, the infant may develop weakness or paralysis in the affected arm.

What Is Erb’s Palsy?

Erb’s palsy is the most common form of brachial plexus birth palsy.

It primarily involves the upper portion of the brachial plexus, often associated with the C5 and C6 nerve roots.

A baby with Erb’s palsy may have:

• Weakness in one arm
• Limited shoulder movement
• Difficulty bending the elbow
• An arm that rests rotated inward
• Reduced sensation
• An asymmetric Moro reflex
• Normal or relatively preserved finger movement despite shoulder and upper-arm weakness

Not every brachial plexus injury has the same pattern.

More extensive injuries can involve additional nerve roots and cause weakness throughout the arm and hand.

How Common Is Brachial Plexus Birth Palsy?

The American College of Obstetricians and Gynecologists’ Task Force on Neonatal Brachial Plexus Palsy reported an overall incidence, including temporary and persistent injuries, of approximately 1.5 per 1,000 births.

The American Academy of Orthopaedic Surgeons similarly describes brachial plexus birth palsy as occurring in roughly one or two out of every 1,000 babies.

Most affected infants improve substantially, but the likelihood and degree of recovery depend on the severity and type of nerve injury.

What Types of Nerve Injury Can Occur?

The American Academy of Orthopaedic Surgeons describes several types of brachial plexus nerve injury.

Neurapraxia

A neurapraxia is a stretch injury in which the nerve is affected but not torn.

This is the most common type of brachial plexus birth injury.

AAOS notes that these injuries often recover naturally, typically within the first few months.

Neuroma

A more significant stretch injury can damage nerve fibers and cause scar tissue to form.

That scar tissue can interfere with signals traveling through otherwise healthy portions of the nerve.

Recovery may occur, but it may be incomplete.

Rupture

A rupture occurs when the nerve itself tears.

Unlike a simple stretch injury, a rupture does not heal on its own in the same way and may require nerve reconstruction or another surgical procedure.

Avulsion

An avulsion occurs when a nerve is torn from the spinal cord.

This is among the most severe forms of brachial plexus injury.

The damaged connection cannot simply be reattached to the spinal cord, although nerve-transfer procedures may sometimes restore some function.

A child can have more than one type of nerve injury at the same time.

What Is Shoulder Dystocia?

Shoulder dystocia is an obstetric emergency that occurs after the baby’s head delivers but the shoulders do not deliver with ordinary gentle traction.

The shoulder may become impacted behind the mother’s pubic bone or, less commonly, against another part of the pelvis.

Shoulder dystocia requires additional obstetric maneuvers to complete the delivery.

Potential complications can include:

• Brachial plexus injury
• Clavicle or humerus fracture
• Oxygen deprivation in a prolonged emergency
• Maternal hemorrhage
• Severe maternal lacerations

The occurrence of shoulder dystocia does not by itself mean the delivery was negligently managed.

Is Shoulder Dystocia Predictable?

Not reliably.

The current ACOG Shoulder Dystocia Practice Bulletin, reaffirmed in 2024, describes shoulder dystocia as an unpredictable and unpreventable obstetric emergency.

Known associations include:

• Larger fetal size
• Maternal diabetes
• Prior shoulder dystocia
• Maternal obesity
• Prolonged labor
• Operative vaginal delivery

But these risk factors have poor predictive value.

Many shoulder dystocia cases occur without warning, while many births involving recognized risk factors proceed without shoulder dystocia.

That makes it important to distinguish between two separate questions:

1. Could the occurrence of shoulder dystocia itself reasonably have been predicted or prevented?
2. Once shoulder dystocia occurred, was it recognized and managed appropriately?

A legal investigation generally cannot assume the answer to either question.

How Is Shoulder Dystocia Managed?

When shoulder dystocia occurs, delivery teams use a sequence of maneuvers intended to release the impacted shoulder.

Common maneuvers can include:

• McRoberts maneuver, involving maternal leg positioning
• Suprapubic pressure
• Delivery of the posterior arm or shoulder
• Internal rotational maneuvers
• Maternal position changes

More advanced rescue techniques may be required when initial maneuvers fail.

The appropriate sequence depends on the circumstances.

American Family Physician’s clinical review, which incorporates ACOG guidance, emphasizes:

• Clearly announcing the shoulder dystocia
• Summoning additional assistance
• Tracking elapsed time
• Using established release maneuvers
• Communicating among the medical team
• Precisely documenting the head-to-body delivery interval and maneuvers performed

ACOG also notes that systematic approaches and simulation training can improve outcomes and documentation.

Can Excessive Traction Cause a Brachial Plexus Injury?

Traction can be one mechanism of brachial plexus injury.

When an infant’s neck and shoulder are stretched far enough, the brachial plexus nerves can be stretched or torn.

For that reason, a birth injury investigation may examine whether excessive lateral traction was applied to the baby’s head during a shoulder dystocia or other difficult delivery.

But the analysis cannot stop there.

The ACOG Task Force on Neonatal Brachial Plexus Palsy emphasized that neonatal brachial plexus injuries have multiple possible mechanisms.

Reported cases have occurred:

• Without clinically recognized shoulder dystocia
• During vaginal deliveries
• During cesarean deliveries

That evidence is important because it means the existence of Erb’s palsy does not establish that excessive clinician-applied traction occurred.

Expert review is usually required to evaluate the injury mechanism in a particular child.

Can a Brachial Plexus Injury Happen Without Shoulder Dystocia?

Yes.

The ACOG/SMFM Task Force report specifically notes published cases of neonatal brachial plexus palsy in which no clinically recognizable shoulder dystocia occurred.

That does not mean shoulder dystocia is irrelevant.

Shoulder dystocia remains an important association with brachial plexus birth injury and can be central to a malpractice investigation.

But the absence or presence of documented shoulder dystocia is only one part of the causation analysis.

Can a Brachial Plexus Injury Occur During a C-Section?

Yes.

The ACOG Task Force report notes that neonatal brachial plexus palsy has been reported following both vaginal and cesarean delivery.

This is another reason why a medical expert should not infer the injury mechanism solely from the diagnosis.

When Might an Erb’s Palsy Case Raise Questions About Medical Negligence?

Potential issues can include the following.

Excessive or Improper Traction During Shoulder Dystocia

A claim may require investigation into:

• How the baby’s head and neck were handled
• Whether traction was applied
• The direction of traction
• Which maneuvers were attempted first
• How quickly the team moved between maneuvers
• Who was present
• How the delivery was documented

The medical records may not always describe the amount of force used.

That makes the overall delivery record, newborn injury pattern, witness testimony, and expert analysis important.

Failure to Use an Organized Shoulder Dystocia Response

Because shoulder dystocia is an emergency, a potential case may examine whether the delivery team:

• Recognized the event
• Called for assistance
• Used accepted maneuvers
• Communicated clearly
• Tracked time
• Progressed appropriately through available maneuvers
• Documented the event

ACOG emphasizes the role of systematic management and simulation training.

A deviation from a preferred sequence does not automatically establish malpractice; experts must evaluate what was reasonable in the actual emergency.

Operative Vaginal Delivery Issues

Forceps and vacuum-assisted delivery remain accepted components of obstetric care when used in appropriate circumstances.

ACOG’s Operative Vaginal Birth Practice Bulletin, reaffirmed in 2025, emphasizes that clinicians using forceps or vacuum extraction must understand proper instrument use and associated risks.

A possible claim may examine:

• Why operative vaginal delivery was chosen
• Fetal position
• Fetal station
• Whether prerequisites were satisfied
• Instrument placement
• Number of pulls or traction attempts
• Vacuum detachments or “pop-offs”
• Whether the attempt was abandoned when appropriate
• Whether cesarean delivery became indicated

Use of forceps or vacuum alone does not prove negligence.

Delivery Planning Questions

Because shoulder dystocia cannot reliably be predicted, the fact that a vaginal delivery was attempted does not itself establish negligence.

In an appropriate case, however, experts may examine prenatal circumstances such as:

• Estimated fetal size
• Maternal diabetes
• Prior shoulder dystocia
• Prior brachial plexus birth injury
• Previous delivery history
• Other maternal or fetal considerations

The question is whether delivery planning was reasonable based on information known before labor and at the time decisions were made.

What Should Be Documented After Shoulder Dystocia?

Detailed documentation can become central to understanding what occurred.

Important information can include:

• Time the baby’s head delivered
• Time the body delivered
• Time shoulder dystocia was recognized
• Which shoulder was impacted
• Personnel present
• Sequence of maneuvers
• Maternal position changes
• Suprapubic pressure
• Posterior-arm delivery attempts
• Internal rotational maneuvers
• Instrument use
• Neonatal condition after delivery
• Resuscitation
• Newborn arm movement
• Fractures or other trauma

American Family Physician’s shoulder dystocia review specifically recommends precise documentation of the head-to-body delivery interval and maneuvers performed.

How Is Erb’s Palsy Diagnosed?

A newborn examination may reveal weakness or loss of movement in one arm.

Evaluation can include:

• Physical examination
• Range-of-motion assessment
• Moro reflex
• Grip strength
• Sensation
• Comparison between arms
• Evaluation for fractures

Depending on the injury, doctors may also use:

• X-rays
• Ultrasound
• MRI
• Electromyography
• Nerve-conduction testing

The timing and usefulness of these tests depend on the child’s age, examination, and suspected severity.

Does Every Baby With Erb’s Palsy Need Surgery?

No.

Many brachial plexus birth injuries improve without surgery.

The American Academy of Orthopaedic Surgeons identifies physical therapy and range-of-motion exercises as the primary nonsurgical treatment.

AAOS states that these exercises commonly begin when the baby is approximately three weeks old, under guidance from the child’s medical professionals.

Their purposes include maintaining motion in the:

• Shoulder
• Elbow
• Wrist
• Hand

and reducing the risk of permanent joint stiffness.

Parents should follow the child’s own specialist or therapist rather than starting exercises based solely on an online description.

When Might Surgery Be Considered?

The answer depends on the type of injury and how the child recovers.

AAOS states that when there is no meaningful change during the first three to six months, a child’s doctor may consider nerve surgery to improve potential function.

Procedures can include:

• Nerve grafting
• Nerve transfers

Other orthopedic procedures may be considered later for persistent limitations involving the shoulder, elbow, or arm.

Because nerve reconstruction can be time-sensitive, persistent weakness should be evaluated by clinicians experienced in brachial plexus birth palsy.

Why Early Follow-Up Matters

A mild stretch injury may improve substantially during the first months of life.

A more severe rupture or avulsion may not.

Early follow-up allows the medical team to document:

• Return of shoulder movement
• Return of elbow flexion
• Hand and wrist function
• Range of motion
• Development of joint contractures
• Differences in arm growth
• Need for imaging or nerve studies
• Whether surgical consultation is appropriate

These same records may later be important in determining the extent and permanence of an injury.

What Records Matter in a Brachial Plexus Birth Injury Case?

The most useful evidence usually spans the pregnancy, delivery, newborn examination, and months of follow-up.

Prenatal Records

Request:

• Complete prenatal chart
• Ultrasound reports
• Estimated fetal weight assessments
• Maternal diabetes testing
• Maternal-fetal medicine records
• Prior obstetric history
• Documentation of previous shoulder dystocia
• Delivery planning discussions

Labor and Delivery Records

Potentially important evidence includes:

• Complete labor and delivery chart
• Nursing notes
• Obstetric notes
• Labor flowsheets
• Electronic fetal monitoring strips
• Oxytocin records
• Cervical examinations
• Fetal position and station
• Delivery note
• Shoulder dystocia note
• Operative report
• Anesthesia records

Shoulder Dystocia Documentation

Specifically request any documentation showing:

• When dystocia was recognized
• Head-to-body interval
• Which shoulder was impacted
• Sequence of maneuvers
• Personnel involved
• Maternal positioning
• Suprapubic pressure
• Posterior-arm maneuvers
• Rotational maneuvers
• Other rescue procedures

The absence of a particular detail in the chart does not prove that something did or did not occur, but contemporaneous documentation can be important.

Forceps or Vacuum Records

If an operative vaginal delivery occurred, request:

• Indication for instrument use
• Fetal position
• Station
• Type of instrument
• Number of traction attempts
• Vacuum detachments
• Duration of the attempt
• Reasons for discontinuing or continuing
• Delivery outcome

Newborn Records

Important evidence can include:

• Initial newborn examination
• Arm movement
• Moro reflex
• Grip
• Sensory findings
• Pediatric evaluation
• Neonatology notes
• Clavicle or humerus imaging
• Other birth-trauma documentation
• Discharge instructions

Follow-Up Records

Save:

• Pediatrician examinations
• Pediatric orthopedic notes
• Hand or upper-extremity specialist records
• Physical therapy
• Occupational therapy
• Range-of-motion measurements
• EMG or nerve studies
• MRI or ultrasound
• Surgical consultations
• Operative reports
• Postoperative rehabilitation

These records may be critical both to medical causation and to documenting the child’s actual long-term impairment.

What Parents Can Do After an Erb’s Palsy Diagnosis

1. Arrange Appropriate Medical Follow-Up

Ask the pediatrician whether your child should be evaluated by a provider experienced in:

• Brachial plexus birth palsy
• Pediatric orthopedics
• Pediatric hand and upper-extremity conditions
• Physical medicine and rehabilitation
• Physical or occupational therapy

Persistent weakness deserves follow-up because treatment decisions may depend on recovery during the first months.

2. Follow the Therapy Plan

Do not invent or modify exercises based on internet instructions.

A pediatric physical or occupational therapist can show you how to safely maintain range of motion and monitor improvement.

3. Request the Complete Delivery Record

Ask for more than the discharge summary.

Request:

• Labor record
• Shoulder dystocia documentation
• Nursing notes
• Delivery note
• Instrument records
• Newborn assessment
• Imaging
• Follow-up records

4. Write Down What You Remember

Parents may remember details that are difficult to reconstruct months later.

Write down:

• What you were told during labor
• Whether staff announced that a shoulder was stuck
• Whether additional personnel entered the room
• Maternal position changes
• What you remember about the delivery
• What staff said afterward
• When you first noticed reduced arm movement
• What providers initially said about the injury

Personal recollection does not replace medical records, but it can help establish a timeline.

5. Photograph or Video Function Over Time

Reasonable home videos can help document changes in:

• Arm movement
• Shoulder elevation
• Elbow bending
• Hand function
• Differences between sides

Do not stage painful or unsafe movements merely for documentation.

6. Keep Therapy and Specialist Records

Preserve:

• PT and OT evaluations
• Home exercise plans
• Range-of-motion measurements
• Equipment or splints
• Specialist notes
• Surgical recommendations
• Bills and insurance correspondence

7. Have Kentucky Deadlines Evaluated Early

Do not assume that every medical malpractice claim involving a newborn can simply wait until the child turns 18.

The proper deadline depends on the claimant, defendant, and legal procedure.

Kentucky Treatment and Early-Intervention Resources

Families do not have to wait for a legal investigation to pursue treatment.

UK HealthCare Hand Center — Lexington

UK HealthCare currently identifies Erb’s palsy as a condition treated through its Hand Center.

Its public information discusses:

• Physical examination
• Imaging
• Nerve testing
• Physical therapy
• Surgical treatment when appropriate
• Ongoing follow-up

The UK HealthCare Hand Center currently lists appointments at 859-323-4263.

Shriners Children’s Lexington

Shriners Children’s provides pediatric treatment for Erb’s palsy and brachial plexus palsy.

Shriners Children’s Lexington provides pediatric orthopedic and upper-extremity specialty care, including expertise in brachial plexus birth palsy.

The Lexington facility is located at:

Shriners Children’s Lexington
110 Conn Terrace
Lexington, KY 40508

Norton Children’s — Louisville

Norton Children’s pediatric rehabilitation services specifically identify:

• Brachial plexus injury
• Erb’s palsy

among the conditions treated by its rehabilitation specialists.

Its pediatric rehabilitation program provides physical, occupational, and speech therapy services at Louisville locations.

Kentucky Early Intervention System

Kentucky also operates the Kentucky Early Intervention System (KEIS).

KEIS is a statewide program for eligible children from birth to age 3 who have developmental disabilities, developmental delays, or qualifying conditions likely to cause developmental delay.

Potential services can address areas such as:

• Physical development
• Communication
• Cognition
• Social and emotional development
• Adaptive skills

Participation does not depend on whether a family has a legal claim.

These healthcare providers and programs are listed only as treatment resources. Their inclusion does not imply that any facility or provider caused a particular child’s injury.

Kentucky Law and Brachial Plexus Birth Injury Claims

Kentucky’s General Medical Malpractice Deadline

Kentucky’s current KRS 413.140 generally requires an action for negligence or malpractice against a covered physician, surgeon, dentist, or hospital to be commenced within one year after the claim accrues.

For the medical malpractice actions identified by the statute, the claim is deemed to accrue when the injury is discovered or, through reasonable care, should have been discovered.

The statute also contains a five-year outside provision measured from the alleged negligent act or omission for covered malpractice claims.

The statute was amended effective July 15, 2026, so older links to prior versions should not be relied upon without checking the current text.

Does Kentucky Toll the Deadline for an Injured Child?

KRS 413.170 applies to certain causes of action when the person entitled to bring the claim was an infant—meaning a minor—when the claim accrued.

Because KRS 413.140 falls within the range of statutes identified in KRS 413.170, minority can significantly affect an injured child’s own medical malpractice claim.

But it is too broad to say that every claim connected with a birth injury can wait until adulthood.

Different deadlines may apply to:

• A parent’s separate claim
• A claim belonging to an estate
• A wrongful-death claim
• Claims involving governmental defendants
• Claims involving a state institution
• Claims governed by another statutory scheme

Each potential claim and defendant should be evaluated separately.

Special Rules Can Apply to State Institutions

Kentucky law has a separate process for certain negligence claims involving the Commonwealth and state agencies.

Under KRS 49.070, state institutions of higher education are treated as agencies of state government for purposes of the Board of Claims statutes, and the Kentucky Board of Claims has primary and exclusive jurisdiction over certain negligence claims involving state agencies and employees acting within the scope of state employment.

KRS 49.120 contains a separate limitations scheme.

For Board of Claims medical malpractice matters:

• Claims generally must be filed within one year after accrual.
• Medical-malpractice accrual includes a discovery rule.
• The statute contains a three-year outside period.
• A guardian, next friend, or other qualified representative must bring a minor’s claim within the applicable Board deadline.

KRS 49.120 expressly provides that its rule for a claimant under legal disability applies notwithstanding KRS 413.170.

This issue can matter if the allegedly negligent care involved the University of Kentucky or another state institution.

It does not mean that every interaction with UK HealthCare creates a Board of Claims case. The provider’s status, employment, the entity involved, and the nature of the claim require legal analysis.

Kentucky’s Certificate-of-Merit Requirement

Kentucky also requires a filing step that was missing from many older summaries of Kentucky medical malpractice law.

Under KRS 411.167, a claimant commencing a covered medical malpractice action generally must file a certificate of merit with the complaint.

The certificate ordinarily states that:

• The claimant reviewed the facts
• The claimant or counsel consulted at least one qualified expert
• The expert is knowledgeable about the relevant issues
• The expert consultation supports a reasonable basis for commencing the action

The statute provides exceptions and alternative procedures for specified circumstances.

It also contains an important medical-records provision.

If requested records have not been produced, the statute addresses when the certificate is due and defines records broadly to include items such as:

• Electronic and paper medical records
• Video
• Fetal heart monitor strips
• Imaging studies

That makes early record requests especially important in a birth injury investigation.

Is a Medical Review Panel Required in Kentucky?

No.

Kentucky previously enacted a mandatory medical review panel system.

In Commonwealth ex rel. Meier v. Claycomb, the Kentucky Supreme Court held the Medical Review Panel Act unconstitutional because it delayed access to Kentucky’s courts.

The old panel requirement therefore does not apply.

The medical review panel should not be confused with Kentucky’s later certificate-of-merit requirement under KRS 411.167.

Do Brachial Plexus Birth Injury Cases Require Medical Experts?

Usually.

These cases often involve medical questions beyond the knowledge of an ordinary juror, including:

• Mechanism of nerve injury
• Shoulder dystocia management
• Obstetric maneuvers
• Traction
• Operative vaginal delivery
• Prenatal risk assessment
• Newborn examination
• Nerve recovery
• Long-term function

Potential experts may include:

• Obstetricians
• Maternal-fetal medicine specialists
• Labor and delivery nurses
• Pediatric neurologists
• Pediatric orthopedic surgeons
• Hand or peripheral nerve surgeons
• Physical medicine and rehabilitation physicians
• Physical and occupational therapists

Kentucky’s current KRE 702, as amended effective July 1, 2024, requires the proponent of expert testimony to demonstrate to the court that it is more likely than not that the testimony satisfies the rule’s reliability requirements.

Those requirements include sufficient facts or data, reliable principles and methods, and a reliable application of those principles and methods to the case.

Do ACOG Guidelines Automatically Establish the Legal Standard of Care?

No.

Professional guidance can provide important medical context, but a guideline alone does not automatically establish negligence or the legal standard of care in a particular case.

The circumstances of the delivery, available resources, individual clinical judgment, other evidence, and qualified expert testimony all matter.

That is especially important in shoulder dystocia cases because the emergency can develop suddenly and different sequences of maneuvers may be reasonable depending on what is happening in the delivery room.

Who Could Be Responsible for a Preventable Brachial Plexus Injury?

Depending on the facts, an investigation may examine care provided by:

• Delivering obstetrician
• Family physician providing obstetric care
• Midwife
• Resident or fellow
• Labor and delivery nurses
• Other members of the delivery team
• Hospital or health system

Potential institutional issues might include:

• Staff training
• Emergency preparedness
• Shoulder dystocia simulation
• Communication systems
• Staffing
• Documentation practices
• Credentialing or supervision where legally relevant

The fact that an individual or hospital participated in the delivery does not establish liability.

Can the Hospital Be Responsible or Only the Doctor?

Potentially either, both, or neither.

The analysis may consider:

• Who provided the allegedly negligent care
• Whether a provider was employed by the hospital
• Whether the provider was an independent contractor
• Whether nursing care contributed
• Whether institutional policies or systems contributed
• Whether the hospital was independently negligent
• Whether governmental or sovereign-immunity issues apply

The answers depend on the particular provider relationships and Kentucky law.

What Damages Can a Persistent Brachial Plexus Injury Cause?

Many children recover significant function.

Others experience lasting impairment.

Depending on the severity of the injury, long-term needs can involve:

• Physical therapy
• Occupational therapy
• Nerve surgery
• Tendon transfer
• Orthopedic surgery
• Splints or braces
• Pain treatment
• Reduced shoulder motion
• Weakness
• Sensory loss
• Differences in arm growth
• Limitations in school or recreation
• Limitations affecting future employment

Potential legal damages depend on the evidence and Kentucky law.

A severe permanent injury may require medical experts, therapists, rehabilitation specialists, vocational experts, or economists to evaluate future impact.

There is no responsible way to estimate the value of a brachial plexus birth injury claim solely from the diagnosis.

Frequently Asked Questions About Erb’s Palsy in Kentucky

What is Erb’s palsy?

Erb’s palsy is a form of brachial plexus birth palsy involving the upper nerves of the brachial plexus.

It can cause weakness or loss of movement in the baby’s shoulder and upper arm.

Is Erb’s palsy the same as every brachial plexus injury?

No.

Erb’s palsy usually refers to an upper-plexus pattern.

Other injuries can involve more extensive portions of the brachial plexus and affect the hand and entire arm.

Does Erb’s palsy prove that too much force was used during delivery?

No.

Excessive stretching can cause a brachial plexus injury, but the ACOG Task Force identified multiple potential mechanisms and noted cases occurring without clinically recognized shoulder dystocia and after cesarean delivery.

Medical expert review is necessary to evaluate causation.

Is shoulder dystocia malpractice?

Not by itself.

ACOG characterizes shoulder dystocia as an unpredictable and unpreventable obstetric emergency.

A legal investigation may instead focus on whether the medical team’s response after the emergency occurred was appropriate.

Is shoulder dystocia always caused by a large baby?

No.

Larger fetal size is a risk factor, but shoulder dystocia also occurs in births involving infants who are not unusually large.

Risk factors generally have poor predictive value.

What should medical staff do when shoulder dystocia occurs?

Management involves calling for assistance and performing established maneuvers to release the shoulders.

Common early approaches include McRoberts positioning and suprapubic pressure, followed as appropriate by additional maneuvers such as delivery of the posterior arm or internal rotation.

The appropriate sequence depends on the circumstances.

What records are most important after a shoulder dystocia?

Important records commonly include:

• Delivery note
• Shoulder dystocia note
• Head-to-body delivery interval
• Sequence of maneuvers
• Personnel present
• Nursing documentation
• Forceps or vacuum records
• Newborn examination
• Imaging
• Pediatric and orthopedic follow-up

Can a brachial plexus injury occur without shoulder dystocia?

Yes.

The ACOG/SMFM Task Force report notes reported cases without clinically recognized shoulder dystocia.

Can Erb’s palsy occur after a C-section?

Yes.

Neonatal brachial plexus palsy has been reported following cesarean as well as vaginal deliveries.

Will my baby’s Erb’s palsy go away?

Many babies recover substantially, particularly when the injury is a less severe nerve stretch.

The prognosis depends on the type and extent of nerve damage.

AAOS notes that simple stretch injuries often recover naturally, while more severe ruptures or avulsions may produce persistent limitations.

When should physical therapy begin?

AAOS states that range-of-motion and physical therapy exercises commonly begin when a baby is around three weeks old.

Your child’s treating clinician or therapist should determine the appropriate timing and exercises.

When is surgery considered?

AAOS states that if there is no change over approximately the first three to six months, a physician may consider nerve surgery.

The correct timing depends on the child’s specific injury and recovery.

Where can families obtain Erb’s palsy treatment in Kentucky?

Current resources include:

• UK HealthCare Hand Center in Lexington
• Shriners Children’s Lexington
• Norton Children’s pediatric rehabilitation services in Louisville

Kentucky’s Early Intervention System may also provide services to eligible children under age 3.

What is Kentucky’s deadline for an Erb’s palsy malpractice case?

Kentucky’s general medical malpractice statute, KRS 413.140, contains a one-year limitations period and a discovery rule for covered medical malpractice claims.

KRS 413.170 can affect certain claims belonging to minors.

Different rules apply in some situations, including claims involving state entities.

There is no single safe filing deadline for every birth injury case.

Does Kentucky require a medical review panel?

No.

The Kentucky Supreme Court struck down the mandatory medical review panel statute.

Does Kentucky require a certificate of merit?

For many medical malpractice actions, yes.

KRS 411.167 generally requires a certificate of merit to accompany a covered complaint, subject to the exceptions and alternative procedures contained in the statute.

Do I need experts to prove a brachial plexus birth injury case?

Usually.

Qualified medical experts generally must address whether the injury mechanism, delivery management, and medical evidence establish negligence and causation.

How Morrin Law Office Evaluates a Brachial Plexus Birth Injury Case

A careful investigation should start with the actual delivery evidence rather than the assumption that every Erb’s palsy injury was preventable.

Our review may involve:

1. Obtaining the complete prenatal and delivery record.
2. Preserving the shoulder dystocia documentation and delivery timeline.
3. Obtaining forceps or vacuum records when instruments were used.
4. Reviewing newborn examination and imaging.
5. Collecting orthopedic, hand, nerve, PT, and OT records.
6. Evaluating the child’s recovery over the first months of life.
7. Consulting appropriate obstetric and pediatric specialists.
8. Considering both traction and non-traction mechanisms of injury.
9. Evaluating whether the shoulder dystocia response was appropriate.
10. Determining whether the medical evidence supports causation.
11. Identifying the appropriate defendants and legal relationships.
12. Determining whether ordinary Kentucky court procedures or Board of Claims rules may apply.
13. Evaluating the certificate-of-merit requirement and filing deadline.
14. Documenting any permanent loss of motion, strength, sensation, or function.

Some cases ultimately support a claim that preventable delivery management caused the injury.

Others show that the brachial plexus palsy likely occurred through a mechanism that does not support negligence.

The purpose of the investigation is to determine what the medical evidence and qualified experts actually support.

Talk With Morrin Law Office About a Brachial Plexus Birth Injury

If your child was diagnosed with Erb’s palsy or another brachial plexus birth injury and you have questions about what occurred during delivery, Morrin Law Office can review the available information and discuss whether further investigation makes sense.

Morrin Law Office
214 W. Main St.
Richmond, KY 40475
Phone: 859-358-0300

Related Morrin Law Resources

• Kentucky Attorney for Accidents Involving Injuries
• Kentucky Passenger Injury Attorney
• Kentucky Wrongful Death Lawyer
• Lexington Personal Injury & Accident Attorney

Sources

• American College of Obstetricians and Gynecologists — Shoulder Dystocia, Practice Bulletin No. 178 (Reaffirmed 2024):
  https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/05/shoulder-dystocia
• Society for Maternal-Fetal Medicine — Executive Summary: Neonatal Brachial Plexus Palsy, Report of the ACOG Task Force:
  https://publications.smfm.org/publications/164-executive-summary-neonatal-brachial-plexus-palsy-report-of/
• American Academy of Orthopaedic Surgeons — Erb’s Palsy (Brachial Plexus Birth Palsy):
  https://www.orthoinfo.org/diseases–conditions/erbs-palsy-brachial-plexus-birth-palsy/
• American Academy of Family Physicians — Shoulder Dystocia: Managing an Obstetric Emergency:
  https://www.aafp.org/afp/2020/0715/p84
• American College of Obstetricians and Gynecologists — Operative Vaginal Birth, Practice Bulletin No. 219 (Reaffirmed 2025):
  https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/04/operative-vaginal-birth
• American College of Obstetricians and Gynecologists — First and Second Stage Labor Management:
  https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2024/01/first-and-second-stage-labor-management
• Kentucky Revised Statutes — KRS 413.140, Current Medical Malpractice Limitations and Discovery Rule:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=58050
• Kentucky Revised Statutes — KRS 413.170, Infancy and Disability Tolling:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17873
• Kentucky Revised Statutes — KRS 411.167, Certificate of Merit for Medical Malpractice Actions:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=49312
• Kentucky Revised Statutes — KRS 49.070, Board of Claims and State Institutions:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=51456
• Kentucky Revised Statutes — KRS 49.120, Board of Claims Filing Deadlines:
  https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=51461
• Kentucky Supreme Court — Amendment of KRE 702, Order 2024-19:
  https://www.kycourts.gov/Courts/Supreme-Court/Supreme%20Court%20Orders/202419.pdf
• Kentucky Supreme Court — Commonwealth ex rel. Meier v. Claycomb (2018):
  https://law.justia.com/cases/kentucky/supreme-court/2018/2017-sc-000614-tg.html
• UK HealthCare — Erb’s Palsy / Hand Center:
  https://ukhealthcare.uky.edu/hand-center/conditions-we-treat/erbs-palsy
• Shriners Children’s — Erb’s Palsy Care:
  https://www.shrinerschildrens.org/en/pediatric-care/erbs-palsy
• Shriners Children’s — Lexington:
  https://www.shrinerschildrens.org/en/locations/lexington
• Norton Children’s — Pediatric Rehabilitation Conditions, Including Brachial Plexus Injury/Erb’s Palsy:
  https://nortonchildrens.com/services/pediatric-rehab-services/pediatric-rehabilitation-conditions/
• Norton Children’s — Pediatric Physical Medicine & Rehabilitation:
  https://nortonchildrens.com/services/physical-medicine-rehabilitation/services/
• Kentucky Cabinet for Health and Family Services — Kentucky Early Intervention System:
  https://www.chfs.ky.gov/agencies/dph/dmch/ecdb/Pages/keis.aspx

Disclaimer

This page provides general public information about brachial plexus birth palsy, Erb’s palsy, shoulder dystocia, and Kentucky medical malpractice law. It is not medical advice or legal advice.

Shoulder dystocia and neonatal brachial plexus palsy can occur in the absence of medical negligence. Medicine, laws, filing requirements, treatment recommendations, and deadlines can change.

If your child has weakness or reduced movement in an arm, discuss diagnosis and treatment promptly with the child’s healthcare professionals. If you have questions about possible legal rights or filing deadlines, consider obtaining individualized legal advice.