Differentials
Clavicle or humeral fracture
SIGNS / SYMPTOMS
Fractures can be associated with brachial plexus birth injury (BPBI) but may be exclusive.
Pseudoparalysis, which is a voluntary restriction or inhibition of motion not due to actual muscular paralysis, may appear clinically similar to BPBI.
Crepitance will be noted at the fracture site and return of normal function will be rapid (2 to 3 weeks) if no nerves have been injured.
INVESTIGATIONS
Radiographs are diagnostic of fractures in this area.
Septic arthritis of the shoulder or proximal humeral osteomyelitis
SIGNS / SYMPTOMS
Paralysis developing late (not present at birth) should be suspected as possible infection.
Pain with movement of the shoulder is suggestive of infection, although it could also be suggestive of fracture.
INVESTIGATIONS
Laboratory tests (CBC with differential, ESR, and CRP) may suggest infection. Ultrasound or MRI will confirm effusion or bony involvement. Bone aspiration: positive culture is diagnostic of osteomyelitis.
Spinal cord or brachial plexus tumor
SIGNS / SYMPTOMS
Paralysis developing after birth without signs of infection or with supraclavicular mass is suggestive of a tumor.
INVESTIGATIONS
Imaging (MRI or CT scan) is diagnostic of spinal cord or brachial plexus tumors.
Parsonage-Turner syndrome
SIGNS / SYMPTOMS
Patients presenting with brachial plexus dysfunction after a viral illness may have this syndrome.
Paralysis develops suddenly after a period of shoulder pain and is unrelated to birth.
INVESTIGATIONS
No differentiating tests are available, because this is a diagnosis of exclusion. MRI of the cervical spine and shoulder and EMG nerve conduction studies of the affected extremity may be performed to localize possible site of injury with brachial plexus birth injury (BPBI) and to help to rule out other causes of sudden paralysis.
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