Pediatric Congenital Torticollis Flashcards
1
Q
Presentation:
A
- Infant postures head in lateral flexion towards one side (involved side) and rotation towards the opposite side
- Torticollis named for side of head tilt
- Noticeable in first few weeks after birth
2
Q
Etiology:
A
- Oligohydramnios
- Trauma during delivery
- Intrauterine malpositioning
- Breech presentation
- Ocular abnormalities
- Osseous abnormalities
- Neurological abnormalities
3
Q
Types:
A
- Congenital muscular torticollis (CMT) results from unilateral shortening of the sternocleidomastoid (SCM) on the same side as the lateral flexion & normal x-rays
- May have palpable mass or fibrosis in SCM possibly due to compromised circulation to SCM
- Congenital Postural Torticollis (CPT) – no SCM tightness, no mass, normal x-rays
- SCM Nodule Torticollis – nodule or fibrous bands in SCM
4
Q
Associated Disorders:
A
- Can cause facial asymmetry and/or unilateral flattening of the occiput (plagiocephaly)
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5
Q
Other Associated Disorders:
A
- Hip dysplasia
- Talipes equinovarus
- Scoliosis
- Brachial plexus injury
- Craniofacial asymmetry-recession of frontal bone, eyebrow and zygoma on ipsilateral side, posterior and inferior ipsilateral ear
- Eye and mouth displacement- ipsilateral eye smaller, canting of mandible
6
Q
Prevalence of Plagiocephaly or Cranial Deformation (CD):
A
- Increased incidence since inception of “Back to Sleep” campaign to reduce SIDS in 1992 – reduced incidence of SIDS by 50%
- This accentuates issues from intrauterine constraint
- “Tummy time” emphasized more now but not widespread knowledge by general public and tolerated less by infants
7
Q
Red Flags:
A
- Acute onset after a long period of symmetry
- Right cervical flexion with right lateral flexion
- C1-C2 instability
- Children with Down syndrome
- Cardiopulmonary
- If signs of respiratory distress–consult
- Trunk arching and neck flexion to right after eating
- GI condition—consult
- Reflux treated with Reglan
- Torticollis can be side effect
8
Q
CMT and Body Structure/Function:
A
- SCM, cervical, upper trap tightness
- SCM, cervical, upper trap weakness
- Asymmetric postures in all positions
- Possible hip dysplasia
- Red and irritated skin folds
- Pain during stretching
- Cervical and thoracic scoliosis
9
Q
CMT and Activity Limitations:
A
- Restricted cervical motion
- Positional preference and â tolerance to prone
- Asymmetrical propping on upper extremities
- Asymmetrical movements and transitions in and between developmental positions
- Resistance to stretching that increases with head control
- Asymmetrical postures in sitting and standing
10
Q
CMT and Participation Restrictions:
A
- Prefers bottle feeding on one side or only breast feeds on one side
- Reduced tolerance to prone play
- Possible delays in development
- Difficulty cleaning infant’s neck
11
Q
CD and Body Structures/Function:
A
- Lateral or bilateral occipital flattening
- Widening of posterior skull or cranial base
- Frontal bossing and/or temporal bulging
- Abnormal vertical growth of posterior skull
- Facial and ear asymmetry
- Mandible asymmetry
12
Q
CD and Activity Limitation:
A
- Visual tracing in supine
- Difficulty fitting eyeglasses
13
Q
CD and Participation Restrictions:
A
- Teasing by peers
- Difficulty bottle or breastfeeding equally on both sides