A 25-year-old motorcyclist sustains a severe traction injury to the upper trunk of the brachial plexus (C5-C6). Which posture of the limb results?

• A Wrist drop with claw hand (Erb-Duchenne palsy)
• B Loss of intrinsic hand muscles with clawing of the ring and little fingers
• C Loss of thumb opposition and thenar wasting
• D Arm adducted, medially rotated, forearm pronated and extended (waiter's tip) ✓

Explanation

Erb-Duchenne palsy results from injury to C5-C6 roots or the upper trunk of the brachial plexus. Muscles paralyzed include deltoid (abduction), biceps (flexion and supination), brachialis, and supraspinatus. The resultant posture—arm adducted and medially rotated, elbow extended, forearm pronated—is classically described as the 'waiter's tip' or 'policeman's tip' position. Claw hand is characteristic of lower trunk (Klumpke's) injury.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.