Pt with h/o shoulder dystocia presents with arm weakness and abnormal arm movements. Parents report that clavicle was broken during delivery. Arm held in adduction with internal rotation and forearm extension; finger movement but no shoulder movement on exam.

• Start daily physical therapy

• Schedule serial exams; consider MRI if no improvement

• Pt advised that surgery may be necessary if improvement does not occur within 3 to 9 months

Notes

• Pathophysiology: Brachial plexus injury (C5-C7) that can occur in utero or during delivery

• Also known as a “waiter’s tip palsy”