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Nursing QUESTION #9272
Question 1
A nurse is evaluating a newborn and notices that the Moro reflex is absent on the left side only, the left arm is held in 'waiter's tip' position (adduction and internal rotation of shoulder, extension of elbow, pronation of forearm). The MOST likely diagnosis is:
  • Cerebral palsy affecting left side
  • Erb's palsy (Upper brachial plexus injury — C5, C6)✔️
  • Klumpke's palsy (C8, T1)
  • Fracture of left clavicle
Correct Answer Explanation

Birth-related Brachial Plexus Injuries:

TypeNerve RootsPresentationCause
Erb's PalsyC5, C6'Waiter's tip': arm adducted, internally rotated, elbow extended, wrist pronated, fingers flexedShoulder dystocia (excessive lateral neck traction)
Klumpke's PalsyC8, T1Claw hand deformity (intrinsic hand muscles paralyzed); Horner's syndrome if T1 root avulsedArm hyperabduction during delivery
Total Plexus PalsyC5–T1Flail arm, complete paralysisSevere traction

'Waiter's tip' = Erb's Palsy (C5–C6). Absent Moro on the affected side (normal Moro requires shoulder abduction/external rotation via C5–C6).

Nursing management:

  • Gentle range of motion exercises after 7–10 days
  • Proper positioning (avoid abduction)
  • Physiotherapy referral
  • Most recover spontaneously in 3–6 months
  • EMG/nerve conduction at 3 months if no improvement
  • Surgical repair (nerve grafting) if no recovery by 3–9 months