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

Traumatic Brachial Plexopathy

Workup

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Media Gallery

Brachial Plexus. Image courtesy of Michael Brown, MD.
Mallet classification.

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Author

Jennifer Semel-Concepcion, MD Director of Physical Medicine and Rehabilitation, St Charles Hospital and Rehabilitation Center; Chair and Professor-Clinical, Department of Physical Medicine and Rehabilitation, State University of New York at Stony Brook School of Medicine

Jennifer Semel-Concepcion, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Jennifer M Gray, DO Staff Physiatrist, Advanced Rehabilitation Medicine/St.Charles Hospital and Rehabilitation Center, Port Jefferson, NY

Jennifer M Gray, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Osteopathic Association, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Hany Nasr, MB, BCh Staff Physician, Department of Physical Medicine and Rehabilitation, State University of New York at Stony Brook

Disclosure: Nothing to disclose.

Anne Conway, PT Clinical Coordinator, Department of Physical Therapy, Children's National Medical Center of Washinton DC

Anne Conway, PT is a member of the following medical societies: American Physical Therapy Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Kat Kolaski, MD Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine

Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Elizabeth A Moberg-Wolff, MD Medical Director, Pediatric Rehabilitation Medicine Associates

Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Merz.

Additional Contributors

Teresa L Massagli, MD Professor of Rehabilitation Medicine, Adjunct Professor of Pediatrics, University of Washington School of Medicine

Teresa L Massagli, MD is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Sections Neonatal Brachial Plexus Palsies
Overview
Presentation
- History
- Physical
- Causes
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DDx
Workup
Treatment
Medication
Follow-up
Media Gallery
References

Neonatal Brachial Plexus Palsies Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

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