Waiter's tip position is commonly associated with:

DSSSB 6 September 2024

Child Health Nursing (Pediatrics)

Easy

Appeared in: DSSSB 6 September 2024

Explanation

Erb's palsy is an injury to the upper roots of the brachial plexus, specifically the C5 and C6 nerves.
This nerve damage leads to paralysis of the muscles responsible for shoulder abduction, external rotation, and forearm supination.
The unopposed action of the remaining intact muscles results in the characteristic 'waiter's tip' posture: the arm is adducted and internally rotated, the elbow is extended, the forearm is pronated, and the wrist is flexed.
This clinical sign is a hallmark presentation of Erb's palsy.

Option B: Facial nerve palsy involves damage to Cranial Nerve VII, resulting in weakness or paralysis of the facial muscles. This causes signs like a unilateral facial droop, not an arm deformity.
Option C: Torticollis, or 'wry neck,' is a condition affecting the sternocleidomastoid muscle. It causes the head to tilt toward one side and the chin to rotate to the opposite side. It does not affect the arm's position.
Option D: Klumpke's palsy is an injury to the lower roots of the brachial plexus (C8 and T1). It classically presents with a 'claw hand' deformity due to paralysis of the intrinsic muscles of the hand.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Association between clinical signs and specific neonatal nerve palsies as background academic context rather than a clinical decision trigger.
Early recognition of the 'waiter's tip' sign is crucial for diagnosing Erb's palsy and initiating timely interventions to prevent long-term disability.
Nursing care focuses on protecting the paralyzed arm from further injury, preventing contractures through prescribed physical therapy, and providing comprehensive education and emotional support to the parents.
What if? - If the infant presented with a 'claw hand' instead of a 'waiter's tip' posture, the diagnosis would shift to Klumpke's palsy. This involves the lower brachial plexus (C8-T1) and requires a different management focus on preserving hand function and assessing for Horner syndrome.

How to Approach the Question

First, identify the key clinical sign presented in the question stem: 'Waiter's tip position'.
This is a classic, pathognomonic sign. Your task is to recall the specific neurological condition associated with it.
Evaluate each option based on your knowledge of neonatal conditions.
Recall that Erb's palsy is an upper brachial plexus injury that results in this specific arm posture.
Differentiate this from Klumpke's palsy (lower brachial plexus, 'claw hand'), Facial palsy (face), and Torticollis (neck).
Select the option that directly corresponds to the 'waiter's tip' sign.

Concept Tested & Keywords

Concept Tested: Association between clinical signs and specific neonatal nerve palsies.
Stem keywords: Waiter's tip position
Lead-in keywords: commonly associated with

QhLPIC8-SQ7-RNLkP5QxcZ

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1077-1079

E6 Obstetrics Williams p. 19-36