q6 - kola

[ArchivalUser]

A 1-day-old infant who was born by a difficult forceps delivery is alert and active. She does not move her left arm, however, which she keeps internally rotated by her side with the forearm extended and pronated; she also does not move it during a Moro reflex. The rest of her physical examination is normal. This clinical picture most likely indicates ?

Options:

1. Fracture of the left clavicle

2. Fracture of the left humerus

3. Left-sided Erb-Duchenne paralysis

4. Left-sided Klumpke paralysis

5. Spinal injury with left hemiparesis

[ArchivalUser]

33

[ArchivalUser]

33333

[ArchivalUser]

Answer is: Left-sided Erb-Duchenne paralysis
In a difficult delivery in which traction is applied to the head and neck, several injuries, including all those listed in the question, may occur. Erb-Duchenne paralysis affects the fifth and sixth cervical nerves; the affected arm cannot be abducted or externally rotated at the shoulder, and the forearm cannot be supinated. Injury to the seventh and eighth cervical and first thoracic nerves (Klumpke paralysis) results in palsy of the hand and also can produce Horner™s syndrome. Fractures in the upper limb are not associated with a characteristic posture, and passive movement usually elicits pain. Spinal injury causes complete paralysis below the level of injury. When paralysis of an upper extremity from injury to the brachial plexus is found in a neonate, injury to the phrenic nerve should also be suspected because the nerve roots are close together and can be injured concurrently. The paralyzed diaphragm can be noted to remain elevated on a chest x-ray taken during deep inspiration when it will contrast with the opposite normal diaphragm in its lower normal position; on expiration, this asymmetry cannot be seen. On inspiration, not only is breathing impaired since the paralyzed diaphragm does not contract, but the negative pressure generated by the intact diaphragm pulls the mediastinum toward the normal side, impairing ventilation further.