Shoulder abnormalities in obstetric plexus palsy

Muscle weakness can lead to poorly formed joint bones. Here, the ball on the main arm bone (humerus) doesn't fit the socket (glenoid). The child's shoulder may be higher than the other one and the collarbone may look short.

General symptoms include:

• weak or limp arm and sometimes wrist and hand
• unusual arm, wrist or hand position
• the arm may be curled inwards and the hand pointing down
• issues with moving the arm
• pain and numbness in their arm or hand
• numbness or trouble feeling their arm or hand

Your consultant will discuss your child's symptoms with you and help to make a diagnosis.

In newborn babies, your consultant may suggest they monitor shoulder development with an ultrasound. This way they can add support to the shoulder to hold it in the right place. In older children, your consultant will see how well your child can move their shoulder and whether it causes them pain. They may order an MRI scan to look at the soft tissues and see whether a nerve is detached.

If your child's symptoms haven't resolved themselves, then your consultant may suggest surgery. If the MRI scan showed a torn nerve, a repair or graft may be undertaken. Here, the torn section of nerve is either reattached at the severed end, or a healthier nerve is grafted from another part of the body. If the shoulder socket is poorly formed, the consultant may suggest an osteotomy. Here, the humerus bone is cut with a surgical saw, in order to fit the shoulder joint. The socket of the shoulder joint (glenoid) is also reshaped (glenoplasty) to hold the ball of the humerus. After surgery, most children stay in the hospital for 2 to 3 days.