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waiter's tip position
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Upper plexus lesions affect mostly C5 and, less frequently, C6. They are usually due to trauma, for example falling on the shoulder, or traction on the arm at birth - in which case the name Erb Duchenne paralysis is given.

The arm hangs at the side with the elbow extended and the forearm pronated; the so-called waiter's tip or Erb's palsy.

On examination, there is loss of:

  • shoulder abduction - deltoid, supraspinatus
  • external rotation - infraspinatus
  • elbow flexion - biceps, brachialis

There may be a slight loss of shoulder adduction.

Treatment is by placing the arm in an abduction splint with a movable joint at the elbow. The prognosis is better for lesions in the neonate than the adult.

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