Congenital Muscular Torticollis

Question 1

CMT

Answer 1

Unilateral shortening of SCM

Question 2

What is the position of baby’s head with CMT

Answer 2

Lateral tilt toward affected side and rotation away from affected

Question 3

How common is CMT?

Answer 3

Third most common after hip dislocation and clubfoot

Question 4

What can CMT be associated with?

Answer 4

Cranial deformation (plagiocephaly)

Question 5

What could CMT be a result of?

Answer 5

Mechanical forces occurring pre- or postnatally

Question 6

Cranial Deformation
– flat on one side

Answer 6

Plagiocephaly

Question 7

Cranial Deformation
– flat on back of the head

Answer 7

Brachyephaly

Question 8

Cranial Deformation
– head is longer

Answer 8

Scaphocephaly

Question 9

When does the posterior fontanelle close?

Answer 9

Age 1 to 2 months

Question 10

When does the anterior fontanelle close?

Answer 10

Age 7 to 19 months

Question 11

Etiology and Pathophysiology

Answer 11

Prenatal factors
Perinatal factors
Associated postnatal factors

Question 12

Etiology and pathophysiology
- prenatal factors

Answer 12

Ischemic injury on abnormal vascular patterns or head position in utero
Intrauterine crowding or persistent malpositioning
Rupture of the muscle
Infective myositis
Hereditary factors

Question 13

Etiology and pathophysiology
- perinatal factors

Answer 13

Birth trauma from breech presentations
Associated deliveries

Question 14

Etiology and pathophysiology
- associated postnatal factors

Answer 14

Presence of hip dysplasia
Positional preference
Presence of deformational plagiocephaly

Question 15

Subjective Exam

Answer 15

Age at the initial visit
Age of onset of symptoms
Pregnancy history
Delivery history
Use of assistance during delivery
Head posture/preference
Family Hx
Developmental milestones
Other known or suspected medical conditions

Question 16

Differential Diagnosis

Answer 16

Neurologic cases of asymmetrical posturing
Musculoskeletal conditions
Acquired torticollis

Question 17

Differential Diagnosis
– neurologic cases of asymmetrical posturing

Answer 17

CNS lesions
Astrocytomas
Brain stem or cerebellar gliomas
Agenesis of CNS structures
Hearing deficits

Question 18

Differential Diagnosis
– MSK conditions

Answer 18

Klippel feil syndrome
Clavicle fracture
Congenital scoliosis

Question 19

Differential diagnosis
– Acquired torticollis

Answer 19

Ocular lesions
Benign paroxysmal torticollis
Infections
Trauma

Question 20

Key Examination Tools for CMT

Answer 20

Cervical PROM
Cervical AROM
Prone tolerance
Gross motor function
Pain
Cervical strength

Question 21

Examination Tools
– cervical PROM

Answer 21

Arthrodial protractor measurement of PROM

Question 22

Examination tools
– cervical AROM

Answer 22

Arthrodial protractor or seated swivel test

Question 23

Examination tools
– prone tolerance

Answer 23

Time per epsiode and episodes per day in prone

Question 24

Examination tools
– gross motor function

Answer 24

Developmental scales

Question 25

Examination scales - pain

Answer 25

Face Legs Activity Cry Consolability scale

Question 26

Examinations scales -- cervical strength

Answer 26

Muscle function scale

Question 27

What is FLACC?

Answer 27

Behavioral pain assessment scale used for nonverbal or preverbal patients who are unable to self-report their level of pain

Question 28

Principles of treatment

Answer 28

Parent/caregiver education Env't adaptations Passive neck ROM Neck and trunk AROM Facilitation of symmetrical movements

Question 29

PT management

Answer 29

Screening to r/o potential causes of asymmetry that are NOT CMT Conducting full exam, dx limitations in body structure and fxn, activities, and participation Prognosis based on severity Intervention Re-examining

Question 30

PT Management -- Re- examing

Answer 30

If progress is adequate If discharge criteria are met Whether referrals to other specialists are needed

Question 31

PT intervention -- Decreased cervical rotation

Answer 31

Manual stretching of tight musculature, active cervical rotation toward nonpreferred side, strengthening of cervical musculature, passive positioning to stretch tight tissues

Question 32

PT intervention -- Head tilt

Answer 32

Manual stretching of tight musculature, active cervical lateral flexion away from head tilt, strengthening of cervical musculature, passive positioning to stretch tight tissues

Question 33

PT intervention -- Positional preference and/or trunk asymmetry

Answer 33

Active movement and strengthening opposite of the preferred side or asymmetry

Question 34

PT intervention -- Prone position intolerance

Answer 34

Increase use of prone positioning to strengthen capital muscles and facilitate symmetrical trunk and head alignment

Question 35

PT intervention -- asymmetrical postures

Answer 35

Active movement and strengthening opposite of the asymmetry

Question 36

PT Intervention -- developmental delay

Answer 36

Facilitate equal use of all extremities and head turning to both directions during daily activities and play