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The removal of diseased supra-clavicular glands is not to be lightly undertaken, as difficulties are liable to ensue in connection with the thoracic duct, the pleura, or the junction of the subclavian and internal jugular veins.
The injury is usually unilateral, it occurs with almost equal frequency in breech and in vertex presentations, and the left arm is more often affected than the right. The lesion is seldom recognised at birth. The first symptom noticed is tenderness in the supra-clavicular region, the child crying when this part is touched or the arm is moved.
The prognosis is less favourable in the supra-clavicular lesions than in those below the clavicle, which nearly always recover without surgical intervention. In the brachial birth-paralysis met with in infants, the lesion is due to over-stretching of the plexus, and is nearly always of the Erb-Duchenne type.
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