These are sometimes very obvious and even the least trained observer can notice them, but frequently they require closer examination. There are specific areas of the musculoskeletal system that need to be evaluated. Frequently the history of traumatic delivery accompanies specific diagnoses such as fractures of the clavicle . These children present very similar to those with congenital brachial plexus palsy with failure of motion of the upper extremity that is pseudoparalysis. These children can be differentiated from children with brachial plexus palsy by palpitation of a tender fracture of the clavicle as opposed to children with brachial plexus injuries who may have swelling or pain with motion in the neck.
Clavicle fractures tend to become pain-free within a few days.
Congenital torticollis is a contracture of the sternocleidomastoid muscle, which tilts the chin to the opposite side and restricts rotation. Spine Examination of the newborn also involves careful examination of the skin for midline skin lesions or dermal pits, which may indicate underlying bone or spinal cord abnormalities. Most significant is to look at the lowermost portion of the spine for dermal pits or skin nevi over the lumbosacral junction, which frequently indicate significant spinal cord problems such as a tether, diastematomyelia or syrinx. Also palpate the sacrum for its presence or abnormalities. Dimples, nevi, or hairy patches at any level require close evaluation.