Neonatal Brachial Plexus Palsies Differential Diagnoses

Updated: Sep 14, 2022
  • Author: Jennifer Semel-Concepcion, MD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Diagnostic Considerations

Preplexus lesions are manifestations of the effects caused by the tearing of a rootlet, root, or spinal nerve that feeds the brachial plexus; these lesions may produce the same clinical findings as brachial plexus palsy, but electrodiagnostic testing can distinguish them from BPP lesions.

Cervical spinal cord injury (SCI) may be involved. Bowel and bladder function should be assessed carefully. Magnetic resonance imaging (MRI) of the spine should be performed in any child with bilateral BPP to rule out an associated SCI.

Patients with hemiparesis should demonstrate the presence of DTRs, an absence of apparent abnormalities in EMG findings, and an exaggerated (not a depressed) Moro reflex.

Patients with hypotonia of central origin should have preserved DTRs and an absence of findings on EMG.

Amyoplasia congenita (a form of arthrogryposis) can be distinguished from BPP by rigidity of the joint and skin dimpling.

Children who have sustained humeral fracture demonstrate pseudoparalysis secondary to pain.

Anterior horn cell injury is unusual, but children with congenital varicella or congenital cervical spinal atrophy can present with a weak or flaccid arm accompanied by reduced sensation.

Differential Diagnoses