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Pediatrics- Exam 1 > Congenital Muscular Torticollis > Flashcards

Congenital Muscular Torticollis Flashcards

1
Q

CMT

A

Unilateral shortening of SCM

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2
Q

What is the position of baby’s head with CMT

A

Lateral tilt toward affected side and rotation away from affected

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3
Q

How common is CMT?

A

Third most common after hip dislocation and clubfoot

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4
Q

What can CMT be associated with?

A

Cranial deformation (plagiocephaly)

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5
Q

What could CMT be a result of?

A

Mechanical forces occurring pre- or postnatally

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6
Q

Cranial Deformation
– flat on one side

A

Plagiocephaly

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7
Q

Cranial Deformation
– flat on back of the head

A

Brachyephaly

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8
Q

Cranial Deformation
– head is longer

A

Scaphocephaly

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9
Q

When does the posterior fontanelle close?

A

Age 1 to 2 months

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10
Q

When does the anterior fontanelle close?

A

Age 7 to 19 months

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11
Q

Etiology and Pathophysiology

A

Prenatal factors
Perinatal factors
Associated postnatal factors

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12
Q

Etiology and pathophysiology
- prenatal factors

A

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

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13
Q

Etiology and pathophysiology
- perinatal factors

A

Birth trauma from breech presentations
Associated deliveries

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14
Q

Etiology and pathophysiology
- associated postnatal factors

A

Presence of hip dysplasia
Positional preference
Presence of deformational plagiocephaly

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15
Q

Subjective Exam

A

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

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16
Q

Differential Diagnosis

A

Neurologic cases of asymmetrical posturing
Musculoskeletal conditions
Acquired torticollis

17
Q

Differential Diagnosis
– neurologic cases of asymmetrical posturing

A

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

18
Q

Differential Diagnosis
– MSK conditions

A

Klippel feil syndrome
Clavicle fracture
Congenital scoliosis

19
Q

Differential diagnosis
– Acquired torticollis

A

Ocular lesions
Benign paroxysmal torticollis
Infections
Trauma

20
Q

Key Examination Tools for CMT

A

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

21
Q

Examination Tools
– cervical PROM

A

Arthrodial protractor measurement of PROM

22
Q

Examination tools
– cervical AROM

A

Arthrodial protractor or seated swivel test

23
Q

Examination tools
– prone tolerance

A

Time per epsiode and episodes per day in prone

24
Q

Examination tools
– gross motor function

A

Developmental scales

25
Q

Examination scales
- pain

A

Face
Legs
Activity
Cry
Consolability scale

26
Q

Examinations scales
– cervical strength

A

Muscle function scale

27
Q

What is FLACC?

A

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

28
Q

Principles of treatment

A

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

29
Q

PT management

A

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

30
Q

PT Management
– Re- examing

A

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

31
Q

PT intervention
– Decreased cervical rotation

A

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

32
Q

PT intervention
– Head tilt

A

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

33
Q

PT intervention
– Positional preference and/or trunk asymmetry

A

Active movement and strengthening opposite of the preferred side or asymmetry

34
Q

PT intervention
– Prone position intolerance

A

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

35
Q

PT intervention
– asymmetrical postures

A

Active movement and strengthening opposite of the asymmetry

36
Q

PT Intervention
– developmental delay

A

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

Pediatrics- Exam 1 (10 decks)

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