Case history
Case history
A newborn infant is examined in the delivery room shortly after birth. The child appears healthy and vigorous, apart from one arm, which is held by the side with the elbow extended, the forearm pronated, and the wrist flexed. Good hand and finger movements are noted. The child does not appear to be in pain and no crepitance is noted over the clavicle or upper arm. The facial features appear symmetric, as do the pupils. History includes a difficult delivery complicated by shoulder dystocia. The pregnancy has been complicated by gestational diabetes. The child is large (>4000 g) and vacuum assistance was used during the delivery.
Other presentations
A child affected by a brachial plexus birth injury (BPBI) may present with a more global involvement of the arm (including poor hand and finger function in addition to elbow and shoulder involvement), compared with a child with an isolated Erb palsy.
Infants with a BPBI may also present with Horner syndrome with pupil miosis, eyelid ptosis, enophthalmos, and anhydrosis on the same side as the brachial plexus injury. Difficulty with feeding or breathing may be encountered with a phrenic nerve injury causing unilateral diaphragm paralysis.
Fractures of the clavicle or humerus may be encountered as crepitance of the affected area.
Approximately half of children with BPBI have no known perinatal risk factors.[2]
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