19.    Look at the posture of this infant.                              

a)        What is your diagnosis?

           Erb's palsy.

b)         Name a common cause of this condition. 

            Injury to brachial plexus due to forceps delivery.

c)         What nerves are affected? 

            C5 and C6. 

d)         Describe the clinical manifestation.

            The affected arm is adducted and internally rotated with the elbow extended; the forearm is in pronatation; and the wrist is palmar flexed. 

e)        What are the aspects of your management?

            1.    Perform x-ray of the shoulder and upper arm to rule out bony injury.

            2.    Examine the chest to rule out associated phrenic nerve paralysis.

            3.    Delay passive movement to maintain range of motion of the affected joints until the nerve edema resolves (7 - 10 days).