Summary
Definition
History and exam
Key diagnostic factors
- paralysis of an arm
- observed decreased motion of an arm
- abnormal posture of the arm
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
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
Diagnostic investigations
1st investigations to order
- x-ray of chest and affected upper extremity (upper extremity 'babygram')
Investigations to consider
- ultrasound scan of the shoulder
- MRI of the shoulder
- CT scan of the shoulder
- EMG/nerve conduction studies
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
Treatment algorithm
Contributors
Authors
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
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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