Last reviewed: March 2019
Last updated: June  2018

Summary

Definition

History and exam

Key diagnostic factors

  • paralysis of an arm
  • observed decreased motion of an arm
  • abnormal posture of the arm
Full details

Other diagnostic factors

  • crepitance of clavicle or humerus
  • Horner's syndrome
  • tachypnoea, respiratory distress, feeding difficulties, failure to thrive
  • lack of full range of passive movement
  • hyper-reflexia, persistent primitive reflexes, abnormal muscle tone, or abnormal body posture
Full details

Risk factors

  • large fetal size (>4000 g)
  • shoulder dystocia
  • maternal diabetes (especially type 1) or gestational diabetes mellitus
  • maternal obesity
  • breech presentation
  • abnormal second phase of labour
  • assisted delivery
Full details

Diagnostic investigations

1st investigations to order

  • x-ray of chest and affected upper extremity (upper extremity 'babygram')
Full details

Investigations to consider

  • ultrasound scan of the shoulder
  • MRI of the shoulder
  • CT scan of the shoulder
  • EMG/nerve conduction studies
Full details

Emerging tests

  • three-dimensional proton-density MRI to assess the brachial plexus
  • volumetric MRI and EMG assessment of rotator cuff muscles
  • ultrasound evaluation of the brachial plexus
Full details

Treatment algorithm

ACUTE

newborns and infants

ONGOING

following initial treatment

Contributors

Authors VIEW ALL

Co-Director

Brachial Plexus Treatment Center

Assistant Director of Pediatric Orthopedic Research

Akron Children's Hospital

Akron

OH

Disclosures

MJA declares that he is on the speakers' bureau for Orthopediatrics implant company and has received compensation to the Department of Orthopaedic Surgery at Akron Children's Hospital for his involvement. He declares that there is no relation of this agreement to the topic of his BMJ article.

Peer reviewers VIEW ALL

Assistant Professor in Child Neurology and Developmental Pediatrics

1st Department of Pediatrics

Aristotle University of Thessaloniki

Thessaloniki

Greece

Disclosures

DIZ is an author of a reference cited in this monograph.

Professor of Orthopedic Surgery

UT Southwestern Medical School

Director of Hand Surgery

Texas Scottish Rite Hospital for Children

Dallas

TX

Disclosures

ME is an author of a number of references cited in this monograph.

Professor

Orthopaedic Surgery

Temple University

Hand and Upper Extremity Surgeon

Shriners Hospitals for Children

Philadelphia

PA

Disclosures

SHK is an author of a reference cited in this monograph.

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