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Brachial plexus neuropathy secondary to septic arthritis and osteomyelitis: report of two cases
1Department of Pediatrics and Surgery, Cathay General Hospital, Taipei, Taiwan, R.O.C.
Insights
Pyogenic osteomyelitis and arthritis of the shoulder joint can cause brachial plexus palsy in infants. Early diagnosis and treatment, including antibiotics and surgery, lead to significant recovery of arm function.
Area of Science:
- Pediatric Orthopedics
- Pediatric Neurology
- Pediatric Infectious Diseases
Background:
- Brachial plexus palsy (BPP) in neonates is often associated with birth trauma.
- Septic arthritis and osteomyelitis of the shoulder are rare causes of BPP in infants.
Observation:
- Two infants presented with right arm weakness at 6 and 10 days of age.
- Clinical examination revealed right arm tenderness and limited passive movement.
- Radiographs showed humeral head abnormalities, and EMG confirmed denervation of C5-C7 muscles.
Findings:
- Cultures identified Streptococcus viridans and Staphylococcus aureus in the shoulder joints.
- Both infants received antibiotics and underwent arthrotomy with drainage.
- Weakness gradually improved with rehabilitation, with near-complete recovery in one infant at 6 months.
Implications:
- Pyogenic shoulder joint infections are a potential, treatable cause of neonatal brachial plexus palsy.
- Prompt medical and surgical intervention can lead to favorable functional outcomes.
- This highlights the importance of considering infectious etiologies in neonatal limb weakness.
Abstract:
Two infants, delivered uneventfully, later developed right brachial plexus palsy secondary to pyogenic osteomyelitis and arthritis of the right shoulder joint. Weakness of right arms occurred at the sixth and tenth days of age respectively. Both had right arm tenderness on palpation and passive movement. Roentgenograms of their right shoulder joints showed irregular radiolucency of the proximal margin of right humerus head. In both cases, electromyography revealed various degrees of significant denervation pattern for the C5-C7 innervated muscles. Pus culture from right shoulder joints grew Streptococcus viridans and Staphylococcus aureus, respectively. After antibiotic therapy and arthrotomy with drainage, weakness improved gradually following continuous rehabilitation. Follow-up at six months of age showed almost complete recovery of right upper extremity function in one patient, but mild residual weakness in the other. Follow-up electromyography studies showed continued improvement. The possible mechanism of this rare occurrence is discussed.