Prenatal brachial plexus paralysis

An 18-day-old child with a history of difficult breech delivery presented with wasting and weakness of C5-6-innervated muscles. The EMG examination performed the same day showed high-voltage polyphasic motor unit potentials without abnormal spontaneous activity. Both the EMG pattern and the clinical features suggest an injury taking place several weeks before delivery. This presumption seems confirmed when compared with findings in our series of 100 EMG examinations in 78 children with diagnosis of Erb's palsy. Because of both clinical and medicolegal implications, early EMG testing is advisable in all patients with congenital brachial paralysis.