Torticolis/ TOS

Question 1

What is congenital torticollis and who is it most commonly seen in

Answer 1

mc in newborns that had difficult births

-vascular insult to SCM causes fibrotic tissue and muscle shortening

Question 2

Tx of congenital torticollis

Answer 2

conservative- stretching (best before 1yo)

Surgical- if after no outcome in 6m

Botox injections

Question 3

what is bony congenital torticollis

Answer 3

congenital deformities of the cervical vertebrea
(shows more tilt then turn)
-may be associated with vertebral artery compromise

Question 4

Etiology of aquired torticollis

Answer 4

can come from any category of the disease, natural history depends on underlying disease in question

usually cuz of fx, neopllasm, neurgoenic

Question 5

what structures are affected in TOS

Answer 5

inf trunk of brachial plexus
Subclavian vein
Subclavian artery

(most commonly affects med side of hand)

Question 6

Incidence of TOS in the pop and most common age range/gender

Answer 6

1-2%

women 3x
typical ages 20-60

Question 7

Triggering factors for TOS

Answer 7

• maintanace of awk pos
• carry heavy weight on back
• working w arms overhead
• sleeping w arms overhead

Question 8

what kinds of trauma can trigger TOS

Answer 8

• blow to basilar region of neck
• sharp jerking motion
• flex/ext type injury

Question 9

Signs and symptoms of TOS

Answer 9

• 100% will have numbness/tingling in medial hand, forearm
• 75% have aching in forearm/hand
• 38% have weakness

*must have tingling for diagnosis, multiple dermatomes affected)

Question 10

best ortho tests for TOs and its specificity

Answer 10

Adsons- palpate radial pulse with hands on side then ak to rotate head to that side and feel for change in pulse, repro of pain

East- pt. eleveates arm 90 degrees in abd ext rot then open/close hands 3 mins

Both- 82% spec

Question 11

what are atrial signs of TOS

Answer 11

• ausculate the subclavian for bruits

- meassure BP in both arms and look for 10-20 mmHg dif

Question 12

what are signs of venous TOS

Answer 12

• blueish color in hands
• unilat swelling
• discolouration may be relieved by elevating arm

Question 13

DDx of TOS

Answer 13

• cerv disk disease
• Carpal tunnal
• Ulnar nerve entrapment

Question 14

chiro tx of TOS

Answer 14

• adress pain first
• exercise for posture
• manip
• muscular relaxtion techniques

Question 15

% of pts that have improvement with neurogenic TOS after tx

Answer 15

76-100%

58-88 after a year