E-Pearl of the Week: The "Cookie Test" for Brachial Plexus Birth Injury

August 16, 2011


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August 16, 2011

The "Cookie Test" for Brachial Plexus Birth Injury

The "Cookie Test" can be used to assess biceps function at 9 months in infants with brachial plexus birth injury and aid in surgical decision-making.

  1. A cookie is placed in the child's hand on the affected side.
  2. The examiner holds the child's elbow adducted at the side to prevent compensation for biceps weakness by flexing the arm in the plane of gravity rather than against it (the "Trumpet Sign").
  3. If the child can bring the cookie to the mouth without bending the neck forward more than 45 degrees, she or he passes the "Cookie Test." If the child does not pass the cookie test, surgical repair of the brachial plexus should be considered.

To learn more about this topic, see the article "Brachial Plexus Birth Injury: What Every Neurologist Needs to Know" in this week's Resident and Fellows section of Neurology: http://neurology.org/content/77/7/695.full


  1. Hale HB, Bae DS, Waters PM. Current concepts in the management of brachial plexus birth palsy. J Hand Surg Am 2010;35:322-331.
  2. Lin JC, Schwentker-Colizza A, Curtis CG, Clarke HM. Final results of grafting versus neurolysis in obstetrical brachial plexus palsy. Plast Reconstr Surg 2009;123:939-948.

Submitted by:
Amy Gelfand, MD

Disclosure: Dr. Gelfand serves as a member of the editorial team for the Neurology Resident and Fellow section.

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