April Week 1: Brachial Plexus Injuries/Clavicular Fractures


Hale, H B, Bae, D S, Waters, P M (2010). Current Concepts in the Management of Brachial Plexus Birth Palsy. JHS, 35A, 322-31.

Hsu, et al. (2002). Neonatal Clavicular Fracture: Clinical Analysis of Incidence, Predisposing Factors, Diagnosis, and Outcome. Am J Perinatology, 19(1), 17-21.

Case 1:

You are doing the admission physical on a full term infant on the postpartum unit. You note that the baby has asymmetry of the clavicles on palpation and decreased movement of the right arm. The baby was born vaginally to a diabetic mother with a birthweight of 4.1kg.

What is your suspected diagnosis? 
What other physical findings may you see?
What studies would you do to confirm the diagnosis? 
How would you treat and what do you tell the parents?

Case 2:

You are doing your NICU rotation and respond to a STAT buzzer for shoulder dystocia and forceps-assisted vaginal delivery. When you arrive, the infant is on the open warmer and crying, but has decreased movement of the right arm with the arm lying internally rotated, extended and pronated.

What other physical findings would you see in a Brachial Plexus Birth injury? 
What other pertinent findings do you want to evaluate for? 
What conditions are in your Differential Diagnosis? 
What studies would you do to rule your diagnosis in or out? 
What are the risk factors for BPI? 
How is BPI classified? 
What is your treatment plan? 
What would you tell the parents regarding outcomes and recovery?