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A baby with a painful shoulder
  1. Charlotte Mount1,2,
  2. Dan Hindley1,2
  1. 1Department of Community Paediatrics, Halliwell Health and Children's Centre, Bolton, UK
  2. 2Departement of General Paediatrics, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK
  1. Correspondence to Dr Charlotte Mount, Halliwell Health and Children's Centre, Aylesford Walk, Bolton, Manchester BL1 3SQ, UK; lottiebrown{at}doctors.org.uk

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CASE HISTORY

A 4-week-old girl presented with 24 hours of pain when moving her right arm. Her mother reported increased sleepiness over the last few hours, with a resolved possible low-grade fever. She was breast feeding well. There was no history of trauma or background social concerns.

She was a term, normal delivery. Her mother had contractions from 35 weeks, and received steroid cover. Maternal high vaginal swabs were group B Streptococcus (GBS) positive; antepartum antibiotic treatment was administered at 36 weeks. Antibiotics were not given in labour (labour was precipitant at 38 weeks) or to baby after delivery; baby received 24 hours of observation prior to discharge.

On examination, she looked well and was apyrexial with stable observations. Right arm pseudoparesis was observed, with swelling and tenderness, but no warmth, over the upper anterior humerus. There was no rash, bruising or other signs of injury.

Initial shoulder X-ray was reported as …

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