A 2-Hour-Old Boy Is Evaluated in the Delivery Room for Minimal

A 2-hour-old boy is evaluated in the delivery room for minimal right arm movement.  He was born at 37 weeks gestation by vacuum-assisted, vaginal delivery to a 39-year-old woman who had excessive weight gain during pregnancy.  The delivery was complicated by a 3-minute shoulder dystocia.  Birth weight was 4.6 kg (10.1 lb) .  Examination shows a small area of edema in the scalp that does not cross suture lines.  The right upper extremity is held in adduction and internal rotation with the elbow extended, forearm pronated, and wrist and fingers flexed.  Moro and biceps reflexes are absent in the right arm.  The remainder of the examination is normal.  Which of the following is the most appropriate next step in management of this patient's condition?

A) Botulinum toxin injections
B) MRI of the brain
C) MRI of the spine
D) Nerve graft procedure
E) Observation only

Correct Answer:

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