Comprehensive examination of the paediatric upper limb including brachial plexus injury assessment, congenital differences, and trauma evaluation with age-appropriate techniques.
Paediatric upper limb examination requires age-appropriate techniques and understanding of common conditions by age group. Examiners expect you to recognize brachial plexus palsy patterns, identify congenital differences, and adapt your examination technique for infants, toddlers, and older children.
High-Yield Exam Summary
Observation is Key:
Primitive Reflexes:
What You Can Assess:
Examination Tips:
Incidence: 1-2 per 1000 live births
Risk Factors:
Recovery:
Brachial Plexus Injury Patterns:
| Type | Roots | Clinical Pattern | Recovery |
|---|---|---|---|
| Erb's | C5-C6 | Waiter's tip (IR, adduction, pronation) | Good |
| Extended Erb's | C5-C7 | Erb's + wrist/finger extension loss | Moderate |
| Klumpke's | C8-T1 | Intrinsic weakness ± Horner's | Variable |
| Global | C5-T1 | Flail arm | Poor |
Classic Posture (Waiter's Tip):
Muscles Affected (C5-C6):
What is Preserved:
Screen for brachial plexus injury in infants
Asymmetric arm abduction and extension
Brachial plexus injury on the side with reduced or absent response
Ability to detect true positives
Ability to exclude false positives
Quantify motor function in OBPP
Graded scale from 0 (no movement) to 7 (full active movement)
Used for tracking recovery and surgical planning - biceps greater than 3 by 3 months is favorable
Ability to detect true positives
Ability to exclude false positives
Syndactyly:
Polydactyly:
Radial Deficiency:
Ulnar Deficiency:
Syndromic Associations:
Common Fractures by Age:
Neurovascular Assessment is Critical:
Neurovascular Examination:
Anterior Interosseous Nerve (AIN):
Median Nerve:
Radial Nerve:
Ulnar Nerve:
Vascular:
Compartment Syndrome - The 6 Ps:
In Children:
Concerning Features:
Upper Limb Specific:
Action:
Inspection:
Palpation:
Movement:
Special Tests:
"3-month-old infant with left arm not moving normally since birth. Uncomplicated vaginal delivery, birth weight 4.5kg."
High-Yield Exam Summary