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Infant not able to life hand. Should I be concerned?

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Dr. Hema Yadav

Pediatrician, Infectious Diseases

Practicing since :2005

Answered : 1528 Questions

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Posted on Mon, 31 Dec 2012 in Child Health
Question: My daughter is born on 6-Dec-2012.
We observed that she is not able to lift her right hand.
There is a movement in her finger, though very little.
1) Shall we wait and watch for some time? Is yes, how much time?
2) Shall we go for some tests quickly? Please suggest the tests to undergo.
3) Are there any exercises that can help?
Please suggest what steps shall we take.
doctor
Answered by Dr. Hema Yadav 54 minutes later
Hello,
Thanks for posting your query.
Answer1. Please consult your pediatrician or pediatric orthopedist as soon as feasible.
Your babys symptoms resemble that of a brachial plexus ( nerve ) injury or a possible fracture any of which needs evaluation and further investigation right away .
Please do not worry as with proper treatment both conditions are likely to be cured in a couple of months.However it's advisable not to wait further and get a confirmed diagnosis as soon as feasible.
Answer 2.First and foremost a thorough examination by a pediatrician can rule out any obvious fracture in which the baby doesn't move the arm due to pain .
In case of nerve injury which is common in normal delivery during labour due to traction on baby's shoulder and arm , the baby will have a floppy arm and absent reflex ( moro's) on that side .
Further an X-ray can help in ruling out musculoskeletal injury ( fracture etc).
Depending on the examination further tests might or might not be needed.

Answer.3 Most babies will fully recover within 3 to 6 months, but those who do not recover have a probable separation of the nerve root from the spinal cord (avulsion)and may need surgery.
Nerve grafts and nerve transfers are sometimes tried.
In cases of pseudoparalysis or fracture the child will begin to use the affected arm as the fracture heals. Fractures in infants usually heal very quickly and easily.
Gentle massage of the arm and range-of-motion exercises are recommended for mild cases.So it's advisable to get your child evaluated by a physiotherapist as well. More severe cases, or those that do not improve in the first few weeks of life may need to be evaluated by pediatric neurology specialists.

The next best step would be consulting a pediatrician or pediatric orthopedist and a physiotherapist simultaneously for further management of the baby.
Hope I have answered your queries.
I'll be available for any further queries.
Wishing your baby a speedy recovery.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Hema Yadav 10 hours later
Thanks a lot for your suggestions.
I forgot to mention couple of things - 1)Delivery was normal 2)The delivery date overdued by 4-5 days. Later on by giving some labor pain medications, pain was introduced. 3) Baby weights aroung 3.75kgs 4)As per the gynac and my wife, the delivery was smooth without any problem.

Please suggest, if any of this fact might give some additional angle.

Initially when our pediatrics analysed, he suggested to wait for 1 month and then go for further tests if the problem does not resolve by itself. Later when my mother seemed a lot worried, he suggested to go for MRI scan. I am not sure if we shall go for this test right away as I am concerned about putting a small kid under these tests right away. are those safe?
doctor
Answered by Dr. Hema Yadav 3 hours later
Hello,
Thanks for the follow up.
Normal delivery with a good weight baby ( 3.75 kg) seems to be more indicative of a shoulder traction causing nerve injury even though the delivery was smooth.
Assuming your pediatrician has ruled out fracture and had an X-ray taken for confirmation ( if not then take that first) , then the baby might have to undergo MRI scan if no cause is confirmed on examination .
Though all investigations including X-ray and MRI have some risk but it's not more XXXXXXX than having something undiagnosed.
However I would not suggest going for MRI rightaway and sincerely feel that an opinion should be taken by consulting an orthopaedic surgeon (specialised in pediatric orthopaedic ) & a physiotherapist . Instead of just waiting for a month I would suggest starting with some exercise therapy rightaway so that the muscles of that hand retain their health and power.
If they rule out any nerve related problem , there is no improvement in another 2 weeks and your pediatrician suspects brain related problem then you should go ahead with the MRI scan. But I feel its not worrisome as of now and most likely just a nerve traction injury which is self healing and will improve with time.So please do not worry and do get a specialist opinion.

Hope I have answered your query.
Kindly accept my answer if you have no further queries.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Hema Yadav 10 minutes later
Thanks doctor.
We will try these steps and get back to you if we get any further queries.

Regards,
XXXXXXX
doctor
Answered by Dr. Hema Yadav 31 minutes later
Hello,
Thanks for the follow up.
Please feel free to ask me any queries. You can directly address your queries to me using "ask this doctor "service on this forum.
Wishing your baby good health.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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