Birth trauma and brachial plexus injury — structured clinical encounter

Station brief (candidate)

You are the neonatal registrar. A term infant (40 weeks, birthweight 4100 g) born after a prolonged second stage complicated by shoulder dystocia (McRoberts manoeuvre and suprapubic pressure required) is found on the routine newborn examination to have an abnormal right arm posture. The arm is adducted and internally rotated at the shoulder, extended at the elbow, and flexed at the wrist. The Moro reflex is absent on the right; hand and wrist movements are preserved. There is no ptosis, miosis, or anhidrosis. The team asks you to classify the injury, exclude the coexisting injuries, establish the management plan, and outline the 3-month threshold decision. You have 12 minutes with the team and 5 minutes for examiner discussion. ^[1]