Erb's Palsy Lawyer in Texas

If your baby was born with a limp arm, a weak grip, or an arm that stays turned in against the body, the doctor may have said Erb’s palsy or brachial plexus birth injury. These injuries happen when the nerves that run from the neck into the arm are stretched or torn during birth. Many babies recover on their own; others face therapy, surgery and lifelong limits in one arm.

Not every brachial plexus injury is someone’s fault. Some happen because the delivery team pulled too hard on the baby’s head, mishandled a stuck shoulder, or ignored warning signs that called for a different plan. Parents rarely get a straight answer about which it was.

This page explains what Erb’s palsy is, how delivery mistakes cause it, what a records review looks for, and the Texas rules that apply. Beverly Law reviews birth injury cases for Texas families for free, through licensed local counsel, in English y Español, with no fee unless we win.

What is Erb’s palsy

The brachial plexus is a network of nerves near the neck that gives rise to all the nerves of the arm. Its roots, labeled C5 through T1, leave the spinal cord in the lower neck and carry the signals that let a child lift the shoulder, bend the elbow and close the hand.

Erb’s palsy is the most common brachial plexus birth injury. It affects the upper roots, C5 and C6, which control the shoulder and elbow, so the arm hangs straight and turned inward and cannot be raised. Klumpke’s palsy is a less common variant that injures the lower nerves and mainly affects the wrist and hand. A total (global) plexus injury damages the nerves from C5 to T1 and leaves the whole arm limp.

Doctors also grade the damage: a stretch (neurapraxia) is the mildest and most common; scar tissue can press on a healing nerve (neuroma); a nerve can be torn (rupture) or pulled from the spinal cord (avulsion). The last two do not heal on their own and usually need surgery.

Brachial plexus birth injuries occur in roughly one to three of every 1,000 births. Many babies improve within the first three to four months; when they do not, the injury is more likely to be permanent.

How mistakes during delivery cause it

The most common setting is shoulder dystocia: the baby’s head is delivered, but one shoulder gets stuck behind the mother’s pelvic bone and the body does not follow. It is an obstetric emergency, and what the team does next often decides whether the baby goes home with a healthy arm.

The nerves are injured when the baby’s head and neck are stretched away from the stuck shoulder. Pulling on the head, bending the neck to one side, or using force to speed a difficult delivery can stretch the nerves past their limit or tear them. The same can happen when tools such as forceps are used and the neck and shoulder are stretched.

The right response to shoulder dystocia is a set of trained maneuvers, not more pulling. The American College of Obstetricians and Gynecologists (ACOG) says a systematic approach and simulation training improve outcomes and documentation. A delivery note showing repeated traction, no maneuvers, or maneuvers in the wrong order becomes central to a negligence review.

Some risk factors are known before labor: a large baby (macrosomia), maternal diabetes, the mother’s weight, a previous shoulder dystocia, a breech position and a prolonged labor. ACOG notes they predict shoulder dystocia poorly in any single birth. But when several are present and documented, the standard of care may require discussing the risks, preparing for the emergency, or offering a cesarean, which lowers the risk even though it does not eliminate it.

Signs parents notice

These injuries are almost always noticed at birth or in the first days of life. Parents and nurses typically see:

If you notice these signs, ask for a pediatric neurology referral and start range-of-motion therapy as soon as the doctor allows, usually at about three weeks of age, so the joints do not stiffen while the nerves heal.

• One arm hangs limp or barely moves while the other moves normally
• No startle (Moro) reflex on the affected side
• The “waiter’s tip” position: arm straight and turned in, wrist bent, palm facing backward
• A weak or absent grip on that side
• Loss of feeling in the arm, or signs of pain when it is moved
• A drooping eyelid or smaller pupil on the same side (Horner’s syndrome)
• A broken collarbone or upper arm bone on X-ray, which often goes with a nerve injury

Is it medical negligence?

In Texas, a medical negligence claim asks one question: did the doctor, midwife or nurse act as a reasonably careful provider would have in the same situation? That level of care is the standard of care. Falling below it and causing harm is negligence.

Some brachial plexus injuries happen without anyone doing anything wrong. Shoulder dystocia is often unpredictable, the nerves can be stretched by the forces of labor itself, and even a cesarean does not remove the risk completely. A limp arm at birth does not, by itself, prove a mistake.

What separates a preventable injury from an unavoidable one is usually in the records. A review looks at whether the estimated fetal weight and maternal diabetes were tracked; whether there was a plan for a large baby; whether forceps or a vacuum extractor were used, and why; and, once the shoulder got stuck, which maneuvers were performed, in what order, and whether excessive force was applied to the head.

The type of injury matters too: an avulsion, a rupture, a total plexus injury, or a nerve injury with a fractured collarbone or arm bone suggests more force than a simple stretch. Beverly Law has obstetric and pediatric neurology experts compare the records against the standard of care before telling a family whether they have a case.

Texas adds a hurdle that often comes up in shoulder dystocia cases. Under Civil Practice and Remedies Code § 74.153, a claim arising from emergency medical care in a hospital’s obstetrical unit requires proof of “willful and wanton negligence,” not just ordinary negligence. In 2018 the Texas Supreme Court held that this standard applied to claims over a shoulder dystocia delivery in a hospital’s obstetrical unit, even though the mother had not come through the emergency room. The rule does not cover care after the patient is stabilized, care unrelated to the emergency, or a provider whose own negligence caused the emergency, and a separate rule, § 74.351, requires a qualified expert’s report within 120 days after each defendant answers the lawsuit. Both are reasons to have the records reviewed early.

Deadline to file in Texas

Texas gives a child’s birth-injury case its own deadline, but it comes with a hard outer limit. Under Civil Practice and Remedies Code § 74.251, a health care liability claim must be filed within two years of the negligent act or of the end of the treatment or hospitalization, but a child under 12 has until his or her 14th birthday. The same statute adds a 10-year statute of repose that applies to everyone, children included, and the Texas Supreme Court enforced it in 2014 against a child injured at birth. For a baby hurt during labor or delivery, that means the case must be filed within 10 years of the delivery at the very latest, before the 14th birthday ever arrives. The clock does not wait for a diagnosis, the parents’ own claims generally have only two years, and the Court has refused to excuse a late filing when the parent waited too long, so it is safer to get advice early.

Many Texas babies are born at hospitals run by public hospital districts, such as Harris Health’s Ben Taub and Lyndon B. Johnson hospitals in Houston, Parkland Health in Dallas, University Health in San Antonio and JPS Health Network in Fort Worth, or at hospitals run by state universities. Claims against a government-run hospital fall under the Texas Tort Claims Act. Under Civil Practice and Remedies Code § 101.101, the governmental unit is entitled to notice of the claim within six months of the incident, describing the injury, the time and place, and what happened, and a city’s charter can require notice even sooner. The statute has no exception for minors, and Government Code § 311.034 makes notice a jurisdictional requirement. The Act also limits what a public entity can pay: under § 101.023, $100,000 per person for a unit of local government and $250,000 per person for the state government or a city. If your baby was born at a public hospital, act right away.

Before a medical malpractice lawsuit can be filed in Texas, each doctor and hospital must get written warning. Under Civil Practice and Remedies Code § 74.051, the notice of claim must be sent by certified mail, return receipt requested, at least 60 days before suit, together with the medical authorization form written into § 74.052; without that form, the case is put on hold until 60 days after it is provided. Proper notice pauses the filing deadline for 75 days for all parties, and the Texas Supreme Court has held that notice sent without the authorization does not. Then, under § 74.351, the family must serve a report from a qualified expert, with the expert’s CV, on each defendant no later than the 120th day after that defendant files its answer. If the report is not served on time, the court, on the defendant’s motion, must dismiss the claim against that defendant with prejudice and award its attorney’s fees. In practice, the medical review has to be well underway before the lawsuit is filed.

What compensation covers

A child with a lasting brachial plexus injury may need care for decades. Compensation is meant to cover the full cost, past and future, so the burden does not fall only on the family.

Medical costs come first: surgery such as nerve grafts, nerve transfers and later tendon transfers; hospital stays; MRI and EMG testing; and follow-up with pediatric neurologists and orthopedic surgeons. Nerve surgery is usually done in the first year of life and tendon transfers between ages one and three.

Physical and occupational therapy can continue for years to keep the joints flexible, build strength and teach a child to use the arm. A claim can also cover braces, adaptive equipment, home modifications and the future care a life-care planner projects the child will need as an adult.

When an arm never regains full function, the child’s lost earning capacity over a working lifetime is part of the claim, along with pain and suffering: the physical pain, the limits on play and sports, and the weight of growing up with a visible disability.

Texas limits one part of a medical malpractice recovery. Under Civil Practice and Remedies Code § 74.301, non-economic damages (pain and suffering, mental anguish, physical impairment, loss of enjoyment of life) are capped at $250,000 for all doctors and other individual providers combined, plus $250,000 per hospital or other health care institution, with no more than $500,000 for all institutions together. These amounts are fixed in the statute and do not rise with inflation, and everyone whose claim comes from one child’s injury, parents included, counts as a single claimant. Economic damages are not capped by § 74.301: lifetime medical care, therapy, equipment, attendant care and lost earning capacity can be recovered in full, although medical expenses are limited to the amounts actually paid or incurred (§ 41.0105). In a birth-injury case, those economic damages are usually the largest part of the claim. If a baby dies, a separate overall limit in § 74.303 applies; it is adjusted for inflation since 1977 and does not include the cost of medical and custodial care.

What to ask the hospital for

In Texas you have the right to a copy of your medical records and your baby’s. Ask in writing and ask for the complete chart, not a summary. In Texas, a hospital must make the records available and provide a copy within 15 days after it receives your written authorization and any allowed fee (Health and Safety Code § 241.154), and a doctor generally within 15 business days (Occupations Code § 159.006).

Request them soon, since some records are kept for a limited time; if the hospital delays, an attorney can obtain them directly. The most useful documents are:

• Prenatal records, including every ultrasound and each estimated fetal weight
• Diabetes screening results and weight gain during the pregnancy
• The labor and delivery record, fetal heart-rate strips, and any use of oxytocin (Pitocin)
• Nursing notes from labor, delivery and the newborn nursery
• Documentation of shoulder dystocia: which maneuvers were used, in what order, and by whom
• Time stamps for delivery of the head and of the body
• Any use of forceps or a vacuum extractor, and the reason given
• The newborn exam and Apgar scores, including Moro reflex, grip and arm movement
• Pediatric neurology consults, EMG results, and imaging such as X-rays and MRI

How Beverly Law helps

Beverly Law is a Los Angeles personal injury firm, and in Texas we take birth-injury cases through licensed local counsel. Birth injury cases turn on medical records, expert testimony and strict deadlines, and Texas adds the 60-day notice and the 120-day expert report. Our team knows how to get the complete chart and put it in front of the right obstetric and pediatric experts.

When you call, someone who speaks your language will listen, explain your options and tell you honestly whether the facts support a claim. If the case goes forward, the records, the experts, the insurance company and the court are handled with licensed local counsel while you focus on your child.

The consultation is free, and there is no fee unless we win. Call 1 (877) 427-2752 any time, in English y Español.

Questions parents ask

Related pages

Cerebral Palsy · HIE / Oxygen Deprivation at Birth · Statute of Limitations · Texas Damage Caps · Texas birth injury lawyers

Important: This page is general information about birth injuries and Texas law, not legal advice, and reading it does not create an attorney-client relationship with Beverly Law. Every case is different — talk to a lawyer about your own situation. Attorney advertising. Prior results do not guarantee a similar outcome. No fee unless we win. Last reviewed: 2026-09-30.