Isolated Bilateral Radial Nerve Palsies in a Newborn (P6.122)

Objective: To present a case of bilateral radial nerve palsies in a newborn caused by birth-related compression injury. Background: Isolated bilateral radial nerve palsies are relatively rare in neonates and frequently mistaken for lower trunk brachial plexopathies. Most cases result from intrauterine compression of one or both radial nerves before or during prolonged labor, or due to direct trauma to the nerve during delivery. Design/Methods: A 4-day old female infant was evaluated for persistent bilateral wrist drop noted immediately after birth. She was born to a primiparous mother at 41 weeks gestation via vaginal delivery following a prolonged labor (20 hours). Her birth weight was 4.430 kg and she required brief cardiopulmonary resuscitation in the delivery room. On examination, she had profound wrist and finger extensor weakness bilaterally, with preserved finger flexion and normal strength in proximal arm muscles. Reflexes were normal. A linear area of ecchymotic discoloration was present across the infant’s chest extending into the lateral aspect of both upper arms, with palpable underlying subcutaneous tissue induration. Results: The differential diagnosis of bilateral wrist drop in neonates includes bilateral radial nerve palsies, lower brachial plexus injury, arthrogryposis, and rarely, central nervous system insults. The presence of ecchymosis and subcutaneous induration overlying the course of the radial nerve at the spiral groove has been reported in other cases of bilateral neonatal wrist drop. This represents an area of subcutaneous fat necrosis strongly suggestive of prolonged radial nerve compression in final stages of pregnancy or during a delivery complicated by difficult progression through the birth canal. Conclusions: Newborns presenting with wrist drop require careful skin inspection for areas or ecchymosis, erythema, ulceration or induration that may indicate radial nerve compression. As opposed to brachial plexopathies, bilateral compressive radial neuropathies have an excellent prognosis in neonates with complete recovery within 6 months in most cases. Disclosure: Dr. Vazquez Do Campo has nothing to disclose. Dr. Starnes has nothing to disclose. Dr. Viorritto has nothing to disclose.