Involves an injury to the nerves of the arm derived from the C5 to C6 levels of the spinal cord.
Presents in a newborn with decreased movement of the involved arm, usually in the "waiter tip" position.
Typically recovers over the course of the first 6 to 12 months of life.
Physical or occupational therapy is used in children with brachial plexus birth palsies to maintain motion and prevent contracture as the nerves reinnervate muscles affected by the initial injury.
Nerve reconstruction or muscle transfer surgery may be needed to improve function in children with incomplete recovery.
Lack of external rotation after brachial plexus injury
Thomas Campbell by commission
- paralysis of an arm
- observed decreased motion of an arm
- abnormal posture of the arm
- crepitance of clavicle or humerus
- Horner syndrome
- tachypnea, respiratory distress, feeding difficulties, failure to thrive
- lack of full range of passive movement
- hyperreflexia, persistent primitive reflexes, abnormal muscle tone, or abnormal body posture
1st Tests To Order
- x-ray of chest and affected upper extremity (upper extremity "babygram")
Other Tests to Consider
- ultrasound scan of the shoulder
- MRI of the shoulder
- CT scan of the shoulder
- EMG/nerve conduction studies
newborns and infants
- initial supportive care
- physical therapy at 2 weeks of age
- with severe injury at birth and/or poor response to physical therapy
- neurosurgical intervention + postsurgery physical therapy
following initial treatment
- monitoring ± physical therapy
- with posterior shoulder subluxation or dislocation
- orthopedic intervention