The brachial plexus is a group of nerves that originate in the cervical spine (neck) and travel down the arm (s). These nerves control the muscles of the shoulder, elbow, wrist and hand, as well as provide feeling in the arm. Some brachial plexus injuries are minor and will completely recover in several weeks. Other injuries are severe and could cause permanent impairment over the entire arm including the elbow (s), hand (s) and wrist (s), which in some instances qualifies as an ADA disability. The more severe injuries will cause limited range of motion of the effected arm, and may result in a shortening of the arm as well. If a child (such as a newborn) has not completely finished his or her physical development at the time of the injury this will adversely affect their crawling and reaching. If it effects their hand and wrist then fingering and grasping can be negatively effected as well.
The brachial plexus nerves can be damaged by stretching, pressure or cutting. Stretching can occur when the head and neck are forced away from the shoulder. If severe enough, the nerves can tear out of the spinal cord in the neck.
Brachial plexus injuries can occur during birth, as well as, afterward as a consequence of injury. Research in one study has shown an incidence of 1–2 per 1000 live births. (J Bone Joint Surg. Am. 2008 Jun;90(6):1258-64. The epidemiology of neonatal brachial plexus palsy in the United States).
Brachial plexus nerve damage has been connected to birth weight, with larger newborns being more susceptible to the injury but, the occurrence can also be caused by delivery methods such as excessive forceful pulling in a difficult delivery with forceps or a vacuum extractor. Breech babies and an obese mother are also associated with brachial plexus injuries.
Many brachial plexus injuries result in vocational impact and earnings loss. With infants suffering a birth injury the loss would be for their entire future work life. A brachial plexus wage loss expert witness can be consulted to calculate loss of earning capacity due to the brachial plexus birth injury.
The loss of earning capacity to a baby over their work life expectancy from a brachial plexus injury varies and is dependent on factors which include: 1. The severity of the brachial plexus injury, 2. The involvement of the hand, elbow, wrist, reach, grasp and range of motion of the arm, and 3. The inherent intellectual functioning of the child.
The reason for assessing intellect is that an average and above average child has a greater likelihood of entering college and completing their degree. The younger the child (ages birth to ten), the less likely their intelligence has been stabilized or by which the I.Q. can be readily and reliably measured. In cases where the child is too young to have their intelligence reliably measured, the parents’ intelligence can be assessed and would be the basis for establishing what a child’s future probable intellectual level would be.
Other vocational issues unrelated to I.Q. but detrimental to employment because of a brachial plexus injury include: 1. Loss of bi-manual dexterity (89% of all jobs in the Dictionary of Occupational Titles use bi-manual manipulation),.2. Persons with brachial plexus injuries do not have the same ability to protect themselves against injury should they fall on the side of the brachial plexus arm and would be a safety risk at some work sites.
Concepts that a brachial plexus wage loss expert witness can address may include: 1. Children with a brachial plexus disability and a college degree have a greater future earnings potential loss when compared to non disabled college graduates, 2. College bound children with brachial plexus disability will have a lessened work force participation compared to those without a disability, 3. Children who have a brachial plexus injury and are not college bound may be limited in their ability to physically perform manual labor. 4. Those who cannot perform manual labor because they may be have difficulty reaching, using manual dexterity, grasping as well as, lifting and carrying ability, will lose access to many jobs, and 5. Children with brachial plexus issues may be subject to discrimination socially and when entering the work force due resultant lower rates of being hired and lost time at work when compared to persons who are not disabled.
Kenneth Manges, Ph.D. is the former President of the American Board of Vocational Experts. Dr. Manges has 30+ years’ experience as a retained expert witness. He has testified as a retained expert witness in State, Federal and Military Matters. Dr. Manges is a vocational expert based in Cincinnati, Ohio who provides loss of earning capacity and ability to work opinions in cases which include birth defects, personal injury and divorce. He may be contacted at manges@drmanges.com or Cell: 513 289-4847.
