Images in Clinical Medicine

Sympathetic-Nerve Damage in Brachial-Plexus Palsy

Israel Alfonso, M.D., and Ilker Yaylali, M.D., Ph.D.

N Engl J Med 2006; 354:2165May 18, 2006

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A mother brought her three-month-old infant to the clinic because of a persistent difference in temperature between the right and left hand. The child had had a total brachial-plexus palsy since delivery. On examination, the child had weakness of the left arm, which was more distal than proximal. His left hand and distal forearm appeared colder than the right by touch (Panel A). The difference in hand temperature was calculated to be 5°C with the use of an infrared camera, with terminal sensitivity of 0.08°C at 30°C (indicated by the difference in color in Panel B). The decreased temperature arises from damage to the sympathetic arm fibers at the first thoracic spinal nerve.

Israel Alfonso, M.D.
Ilker Yaylali, M.D., Ph.D.
Miami Children's Hospital, Miami, FL 33155

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