A 5-day-old neonate has a completely flail right arm with no sensory response, ptosis and miosis on the same side. MRI shows pseudomeningoceles at two levels. What is the appropriate management?

• A Physiotherapy alone with review at one year
• B Tendon transfers once the child reaches five years of age
• C Early microsurgical exploration and reconstruction within the first three months ✓
• D Shoulder arthrodesis at skeletal maturity

Explanation

Horner syndrome plus pseudomeningoceles indicates preganglionic root avulsion, which has essentially no potential for spontaneous recovery. Such infants are candidates for early microsurgical exploration rather than prolonged observation. Physiotherapy alone is reserved for milder upper trunk palsies showing serial recovery of biceps and deltoid. Tendon transfers and arthrodesis are salvage procedures considered later, only after nerve surgery has failed or been impossible.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.