Reverse Putti sign in late brachial plexus birth palsy: A case illustration and pathophysiological insights

The “Reverse Putti Sign” is a newly identified clinical finding observed in late-stage brachial plexus birth palsy (BPBP), characterized by the superior protrusion of the scapula when the shoulder is adducted and internally rotated. This sign contrasts with the traditional Putti sign, which is associated with glenohumeral abduction contracture and external rotation. The reverse Putti sign suggests a glenohumeral adduction contracture, likely resulting from denervation or weakness of the shoulder adductors, leading to abnormal scapulothoracic motion. This case study highlights the significance of the reverse Putti sign in diagnosing shoulder deformities in BPBP patients, emphasizing the importance of early detection and tailored therapeutic interventions to prevent further complications. Understanding this novel sign broadens the clinical scope for managing BPBP and underscores the complexity of shoulder contractures in these patients.