A 1-Day-Old Boy Is Evaluated in the Nursery for Minimal

A 1-day-old boy is evaluated in the nursery for minimal right-hand movement.  He was born at 39 weeks gestation by forceps-assisted, vaginal delivery to a mother with insulin-controlled gestational diabetes mellitus and obesity.  The delivery was complicated by shoulder dystocia.  Birth weight was 4.4 kg (9.7 lb) .  Examination of the right upper extremity shows extension of the wrist, hyperextension of the metacarpophalangeal joints, and flexion of the interphalangeal joints.  Grasp reflex is absent.  Moro and biceps reflexes are intact.  There is no crepitus.  The left arm is normal.  There is slight ptosis of the right eyelid, and the right pupil is 2.5 mm smaller than the left.  The remainder of the examination is unremarkable.  Which of the following is the most likely cause of this patient's presentation?

A) Fracture of the right clavicle
B) Fracture of the right humerus
C) Injury to the 5th and 6th cervical nerves
D) Injury to the 8th cervical nerve and 1st thoracic nerve
E) Perinatal asphyxia
F) Perinatal ischemic stroke

Correct Answer:

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