An infant with a brachial plexus injury may have a disorder of the shoulder that can be subtle.
Patient selection: infant with obstetric brachial plexus injury
Shoulder injuries include:
(1) shoulder dislocation
(2) shoulder contracture
Criteria for a shoulder dislocation on ultrasonography - the presence of both of the following:
(1) percentage of humeral head displaced posterior to the axis of the scapula > 50%
(2) intersection of the posterior scapular margin with a line tangential to the humeral head through the glenoid (alpha angle) > 30 degrees
Dislocation of the shoulder can be identified on ultrasonography of the shoulder when passive external rotation in abduction <= 60 degrees.
The presence of a shoulder contracture should be suspected in infants with an early elbow flexion contracture (odds ratio 2.5). The presence of a shoulder contracture is associated with a reduced range of motion.
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