In total brachial plexus palsy following birth trauma, the Narakas classification type IV includes:

• A C5-C6 palsy with preserved elbow flexion
• B C5-C7 palsy with wrist drop but intact hand
• C C5-T1 palsy with flail limb and no Horner's syndrome
• D C5-T1 palsy with flail limb and Horner's syndrome ✓

Explanation

The Narakas classification of obstetric brachial plexus palsy: Type I = C5-C6 (Erb's palsy, 46%); Type II = C5-C7 with wrist drop; Type III = complete C5-T1 flail limb without Horner's; Type IV = complete C5-T1 flail limb with Horner's syndrome (worst prognosis, indicates T1 avulsion with sympathetic involvement). Type IV has the poorest prognosis with a high rate of preganglionic injury requiring nerve transfer surgery. Spontaneous recovery is least likely in type IV.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.