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Erb palsy — RACP Paediatrics MCQ

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EasyNeonatalErb palsyRACP Paediatrics

A large-for-gestational-age neonate delivered after shoulder dystocia has the right arm in a 'waiter's tip' position (adducted, internally rotated, elbow extended, forearm pronated, wrist flexed). There is no Moro reflex on the right. Left arm is normal. What is the most likely birth injury?

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Correct answer: B — Erb palsy (C5-C6)

The 'waiter's tip' position with absent ipsilateral Moro reflex after shoulder dystocia is classic Erb palsy (upper brachial plexus injury, C5-C6). Most cases (~80-90%) resolve spontaneously within 3-6 months with physiotherapy. Persistent weakness beyond 3 months may require surgical exploration.

Reference: RCH Melbourne – 2023 – Birth Injuries CPG; RACP Paediatric Curriculum – Neonatology