Neonatology: Brachial Plexus Injuries

Front 1

What is the typical resting position of the arm of an infant with a brachial plexus injury?

Back 1

"Waiter's tip" or "Chicago cop seeking bribe"

Front 2

Name 8 items in the birth history that should direct you to consider a brachial plexus injury.

Back 2

1. Shoulder dystocia

2. Large birth weight (over 4000 gm)

3. Forcep delivery

4. Prolonged labor

5. Multiparty

6. Gestational diabetes

7. Clavicle fracture

8. Humerus fracture

Front 3

What sympathetic nervous syndrome is associated with a brachial plexus injury?

Back 3

Horner's Syndrome

1. Ptosis

2. Miosis

3. Anhydrosis of affected side of face

Front 4

What is a "flail arm"? (5 points to remember)

Back 4

1. The most extreme of brachial plexus injuries

2. Caused by the complete disruption of innervation to the arm

3. The arm cannot be moved or feel sensation.

4. Over time it withers

5. Best management is amputation and replacement with a prosthesis

Front 5

Left to themselves, how many newborns with brachial plexus palsy will recover completely?

Back 5

60% will recover spontaneously and completely--but no one can say at birth which of them will be so lucky.

Front 6

Name 5 problems caused by brachial plexus injury that generally are not related to arm problems.

Back 6

1. Respiratory distress (related to phrenic nerve injury and diaphragm impairment)

2. Poor feeding (ditto)

3. Failure to thrive (ditto)

4. Horner's syndrome

5. Diaphragm asymmetry

Front 7

Name 5 physical findings involving the arm that might be noticed in a newborn with a cervical plexus injury.

Back 7

1. One arm affected

2. Abnormal resting position ("Chicago Cop")

3. Weakness/paralysis of shoulder, arm, and/or hand.

4. Dislocated shoulder

5. Asymmetric moro and tonic neck reflexes in youngest infants

Front 8

What is the incidence of brachial plexus injuries in newborns?

Back 8

1-2 in 1000 births

Front 9

Name 4 diagnostic aids potentially useful in evaluating brachial plexus injuries

Back 9

1. MRI

2. Electromyography (EMG)

3. CT scan with myelogram

4. X-rays

Front 10

Name a sign of good prognosis for complete recovery from a brachial plexus injury.

Back 10

Those infants with full recovery of elbow flexion at 2 months of age generally get complete recovery of arm function by their 2nd birthday.