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MSK 3 final > Congenital Muscular Torticollis > Flashcards

Congenital Muscular Torticollis Flashcards

1
Q

definition:

A

postural deformity evident shortly after birth

typically presenting as side bending of the neck to one side and head or chin rotation to the opposite side

due to shortening of sternocleidomastoid muscle on one side of the neck

may be accompanied by other msk or neurological conditions

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2
Q

named by:

A

side of the tight muscle

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3
Q

torticollis R sided =

A

nose/face rotates to L

R ear tilts to R shoulder

tight R SCM muscle

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4
Q

incidence:

A

1 in 6 newborns (16%)

more prevalent in males - 3:2

15% of babies with CMT also have hip dysplasia

CMT frequently is accompanied with cranial deformation = distortion of shape of skull due to mechanical force occurring prenatally and postnatally

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5
Q

types of CMT

A

postural
muscular
SCM mass

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6
Q

postural CMT

A

most mild form

infant exhibits postural preference without muscle tightness or restriction to PROM

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7
Q

muscular CMT

A

characterized by tightness of SCM muscle and limitation of PROM

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8
Q

SCM mass CMT

A

most severe form

presents with thickening of SCM muscle and restricted PROm

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9
Q

etiology:

A

prenatal factors
perinatal factors
postnatal factors

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10
Q

prenatal factors:

A

longer body length

intrauterine crowding

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11
Q

perinatal factors:

A

birth trauma

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12
Q

postnatal factors:

A

positional preference
containers
gastrointestinal reflux

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13
Q

identification - who?

A

physicians
nurse
midwives
obstetrical nurses
nurse practitioners
lactation specialists
PTs
any clinician or family member

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14
Q

identification - what?

A

refer infants to their primary physician and a PT with expertise in infants

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15
Q

identification - when?

A

earlier the better if they notice:

postural preference
reduced cervical ROM
SCM mass
craniofacial asymmetry

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16
Q

prognosis:
referral before 1 month

A

98% of infants achieve near normal range within 1.5 months

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17
Q

prognosis:
referral between 1-6 months

A

prolongs interventions to about 6 months

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18
Q

prognosis:
referral after 6 months

A

requires 9+ months of intervention with fewer infants achieving near normal range

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19
Q

possible complications if untreated:

A

1) trouble bringing their hands to midline

2) delayed visual development and visual tracking

3) problems with motor planning

4) decreased or limited protective responses on affected side

5) asymmetrical motor skills and transitional movements

6) cranial deformation

**they are always lying on that side

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20
Q

shortening of the ____ shortly after birth

A

sternocleidomastoid

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21
Q

named by ____

A

side of tight muscle

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22
Q

frequently accompanied with ____

A

cranial deformation

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23
Q

can lead to delays in ____ and ____

A

motor
visual development

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24
Q

_______ and ______ is key

A

early diagnosis
treatment

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25
Q

Examination:

A

document infant history
routines
exam body structures
strength and mobility

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26
Q

Family Interview - History

A

Age at initial visit (chronological and corrected age)

Age of onset of symptoms

Pregnancy history including maternal sense of whether the baby was “stuck” in one position during the final 6 weeks of pregnancy

Delivery history including birth presentation (cephalic or breech); use of assistance during delivery such as forceps or vacuum suction

Head posture/preference and changes in the head/face

Family history of torticollis or any other congenital or developmental conditions

Other known or suspected medical conditions

Developmental milestones appropriate for age

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27
Q

Family Interview - Routines

A

feeding

sleeping

tummy time

time in equipment/devices

daycare/sitter

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28
Q

Posture and Positioning

A

Observe the infant in all positions, documenting alignment, preferred positioning, posturing, and tolerance

supine

prone

supported upright positions

sidelying

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29
Q

supine =

A

Document the side of torticollis, asymmetrical hip, trunk, and extremity positions, facial and skull asymmetries, restricted AROM

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30
Q

prone =

A

Document asymmetry of the spine, the head on the trunk, asymmetrical use of the extremities, and the infant’s tolerance

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31
Q

supported upright positions =

A

Document asymmetrical preferential postures and compensations in the shoulders, trunk, and hip

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32
Q

side lying =

A

Document asymmetries, trunk flexion or extension, head lifting, leg position

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33
Q

Bilateral AROM – Cervical Rotation and Lateral Flexion

A

Assess in supine and supported upright if age appropriate

Asymmetrical and compensatory movements can indicate muscle tightness, restrictions or weakness

Treatment to improve AROM consistent with goals of early intervention

34
Q

Bilateral PROM – Cervical Rotation and Lateral Flexion

A

Severity of CMT determined by difference between left and right PROM measures of cervical rotation

35
Q

Normal value passive cervical rotation for child
< 12 months:

A

110 ± 6 degrees

36
Q

Normal value passive lateral flexion for child
< 12 months:

A

70 ± 2.4 degrees

37
Q

Bilateral AROM/PROM – Upper and Lower Extremities

A

Document infant’s natural movements

Passively move arms and legs through all available range at each joint

Passively move ribs and spine

38
Q

Bilateral AROM/PROM – Upper and Lower Extremities

rule out:

A

Developmental dysplasia of hip (DDH): observe for symmetry and stability of hip, leg length symmetry, gluteal skin folds, hip scour test, Barlow and Ortolani Maneuvers

Brachial plexus injuries or clavicle fractures

Neurological impairments

Hypermobility

CNS lesions

Scoliosis

39
Q

Document any behaviors reflective of ____ reactions in the infant and child during the examination process

A

discomfort, or pain

40
Q

Pain or Discomfort =

A

Pain is not typically associated with the initial presentation of CMT

The FLACC is recommended to document baseline status

The PT should work with the parents and caregivers to differentiate actual pain responses from discomfort or behavioral reactions to stretching, anxiety, or the stress of an unusual environment.

41
Q

Skin Integrity =

A

Document skin integrity

Symmetry of neck and hip skin folds

Presence and location of SCM mass

Size, shape and elasticity of SCM muscle and secondary muscles

42
Q

Up to 90% of infants with CMT will also have ___

A

craniofacial asymmetry

43
Q

Craniofacial Asymmetries and Head/Skull Shape:

A

Document cranial deformities, including plagiocephaly, brachycephaly, and dolichocephaly

44
Q

Craniofacial asymmetries on the side of the torticollis may include:

A

smaller and elevated eye with changes in the orbit

recession of the ipsilateral ear

a reduced jaw height with malocclusion

possible gum line asymmetry

45
Q

Cranial Deformations =

A

Plagiocephaly
Brachycephaly
Dolichocephaly

46
Q

Plagiocephaly –

A

most common type of infant flat head syndrome. Generally, the back of the baby’s head is flat on one side

47
Q

Brachycephaly –

A

second most common type of flat head syndrome. The back of the head is flattened instead of curved

48
Q

Dolichocephaly –

A

less common type of flat head syndrome

The head is flattened on both sides

49
Q

Severity Ratings: Plagiocephaly

A

Cranial Vault Asymmetry Index (CVAI):

Mild: 3.7
Moderate: 5.2
Severe: 7

50
Q

Severity Ratings: Brachycephaly

A

Cephalic Ratio (CR):

Mild: 81-86
Moderate: 87-92
Severe: 92

51
Q

Craniosynostosis vs Plagiocephaly

A

affect the shape of an infant’s skull

Premature closure of one or more cranial sutures

Prevalence ranges from 0.4% to 0.07%

Requires referral to neurosurgery

52
Q

Plagiocephaly =

A

ipsilateral frontal bossing

ispilateral displaced anteriorly

ipsilateral occipitoparietal flattening

contralateral occipital bossing

53
Q

Craniosynostosis =

A

contralateral frontal bossing

ispilateral displaced posteriorly

ipsilateral occipitomastoic flattening

ipsilateral occipital bossing

contralateral bossing

54
Q

Gross Motor Function

A

Test of Infant Motor Performance (TIMP)

Alberta Infant Motor Scale (AIMS)

Peabody Developmental Motor Scales (PDMS-2)

55
Q

Test of Infant Motor Performance (TIMP):

A

0-4 months

56
Q

Alberta Infant Motor Scale (AIMS):

A

0-18 months

57
Q

Peabody Developmental Motor Scales (PDMS-2):

A

0-5 years

*Gross Motor Subtests

58
Q

Muscle Function Scale (MFS):

A
  1. head very high above horizontal line - almost vertical position
  2. head high above horizontal line and more than 45 degrees
  3. head high above horizontal line but below 45 degrees
  4. head slightly above horizontal line
  5. head on horizontal line
  6. head below horizontal line
59
Q

Severity Level Classification

A

grade 1: early mild
grade 2: early moderate
grade 3: early severe
grade 4: later mild
grade 5: later moderate
grade 6: later severe
grade 7: later extreme
grade 8: very late

60
Q

grade 1: early mild

A

0-6 mo: postural preference OR passive cervical rotation difference < 15°

61
Q

grade 2: early moderate

A

0-6 mo: passive cervical rotation difference between sides 15-30°

62
Q

grade 3: early severe

A

0-6 mo: SCM mass OR passive cervical rotation difference between sides > 30°

63
Q

grade 4: later mild

A

7-9 mo: postural preference OR passive cervical rotation difference < 15°

64
Q

grade 5: later moderate

A

10-12 mo: postural preference OR passive cervical rotation difference < 15°

65
Q

grade 6: later severe

A

7-9 mo: passive cervical rotation difference > 15°

10-12 mo: passive cervical rotation difference 15-30°

66
Q

grade 7: later extreme

A

7-12 mo: SCM mass

10-12 mo: passive cervical rotation difference > 30°

67
Q

grade 8: very late

A

12+ mo: SCM mass, any asymmetry, OR any passive cervical rotation difference

68
Q

Treatment – First Choice

A

Neck PROM

Neck & Trunk AROM

Symmetrical Movement Development

Environmental Adaptations

Parent/Caregiver Education

69
Q

Neck PROM –

A

Gentle stretching

Should not be painful to baby and stopped if infant resists or parent perceives changes in breathing or circulation

Each cheek on caregiver’s chest or floor.

70
Q

Neck & Trunk AROM –

A

Exciting things to the non-preferred side. Tummy time, short spurts, total > 1hr/day.

71
Q

Symmetrical Movement Development –

A

Both sides, both ways.

Sidelying, rolling, reaching.

Want bend and twist, not arching.

72
Q

Environmental Adaptations–

A

Carry baby vs keeping them in holders, use towel rolls inside of swing or holder

73
Q

Parent/Caregiver Education–

A

Alternate sides for holding, feeding and changing diaper

74
Q

Discharge Criteria:

A

PROM within 5 degrees of the non-affected side

Symmetrical active movement patterns

Age-appropriate motor development

No visible head tilt

Parents/caregivers understand what to monitor as the child grows

75
Q

Re-Assess:

A

3-12 months following discharge from PT intervention OR when the child initiates walking

76
Q

Re-evaluation should include:

A

Positional preference

Symmetry of movement

Developmental milestones

77
Q

Consult Primary Care:

A
  1. When asymmetries of the head, neck, and trunk are not starting to resolve after 4-6 weeks of comprehensive intervention.
  2. After 6 months of treatment with a plateau in resolution.
78
Q

Cranial Reshaping Helmet?

A

Head shaping not improving with positioning

4-10 months old

Length depends on severity

79
Q

Examination includes:

A

infant history, routines, body structures/posture, strength and mobility

80
Q

Use ___ to classify severity level

A

decision tree

81
Q

Follow ___ interventions

A

first choice

82
Q

Use discharge criteria for ___ and ___

A

developing goals
plan of care

MSK 3 final (9 decks)

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