Neonatal Septic Shoulder Joint Masquerading as Brachial Plexus Palsy: A Case Report and Review of the Literature

TL;DR

A 2-week-old baby with shoulder joint infection was initially thought to have a brachial plexus injury, highlighting the need for early imaging in such cases.

Contribution

This case highlights septic arthritis in neonates mimicking brachial plexus palsy and emphasizes the importance of early imaging for accurate diagnosis.

Findings

The neonate showed signs of C5/6 palsy but was diagnosed with septic shoulder joint arthritis via MRI.

Surgical washout and antibiotics led to full recovery with normal shoulder movement at 7 months.

Neonates with suspected brachial plexus palsy without trauma should be evaluated for joint infection.

Abstract

Case: A 2-week-old girl presented to the hospital with a 1-day history of decreased spontaneous movements of her left arm at the shoulder and elbow. There was no history of trauma, and she was otherwise well. Clinically, there was evidence of a C5/6 palsy. MRI of the left shoulder demonstrated an effusion and synovial thickening at the left glenohumeral joint. She was managed with a surgical washout of the joint and intravenous antibiotics. At a 7-month follow-up, she demonstrated a symmetrical range of movement in both shoulders with no signs of acute or chronic infection on X-ray.

Conclusion: Septic arthritis of the glenohumeral joint presents insidiously in neonates and infants without typical signs of infection. Neonates and infants presenting with suspected brachial plexus palsy without a convincing history of trauma should raise suspicion of underlying joint infection and be investigated accordingly with blood tests and a low threshold for imaging of the shoulder to facilitate early diagnosis and management.

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