Torticollis

Question 1

Muscular torticollis is the ____ most common congenital msk anomaly after dislocated hip and clubfoot

Answer 1

third

Question 2

What are the risk factors for torticollis?

Answer 2

large birth weight, male, breech, multiples, first time mothers, difficult labor and delivery, nuchal cord, maternal uterine abnormalities, intrauterine growth restriction

Question 3

What are the 3 classifications of CMT?

Answer 3

postural, congenital, mass

Question 4

match the correct classification of CMT with its definition:
_____: fibrotic thickening of SCM, PROM and AROM limitations and most severe form
_____: SCM tightness w/ PROM and AROM limitations
_____: presents as infant’s postural presence, ABSENCE of mm PROM restrictions, mildest form

Answer 4

Mass
Congenital
Postural

Question 5

Which is the most severe form of CMT, mildest?

Answer 5

Mass, Postural

Question 6

Describe the typical presentation of mass torticollis

Answer 6

appearance of fibrous tumor about 2 weeks after birth (can appear as late as 3 months), disappears by the time the patient is 4-8 months, biopsy reveals that there is a histologic appearance of a fibroma, may be an associated head hilt, INFANT CAN’T MAINTAIN VERTICAL HEAD AGAINST GRAVITY IN STATIC POSTURES OR DURING TRANSITIONAL MOVEMENTS

Question 7

torticollis causes decreased ROM of ____ rotation and asymmetric cervical flexion and extension

Answer 7

ipsilateral

Question 8

t/f, a child with torticollis is able to maintain midline alignment w/ torso in static postures during movement

Answer 8

false, not able to maintain midline alignment

Question 9

What facial features here would point towards CMT?

Answer 9

asymmetry of ipsilateral jaw, inferiorly and posteriorly positioned ipsilateral ear, asymmetrical eyes with ipsilateral eye being smaller, cranial base deformation

Question 10

What is the prognosis for CMT?

Answer 10

earlier identification= shorter treatment, postural cmt has shorter treatment time, cmt mass may have to undergo invasive treatment options, id less than 1 month=> 1.5 month tx, bw 1-6 months=> tx up to 6 months, greater than 6 months dx=> more than 9 months tx

Question 11

What can having cmt do to the rest of the child’s body?

Answer 11

trunk mimics what head and neck are doing so if the neck is flexed, the trunk will flex too which has implications for proper development

Question 12

What are some potential red flags in infants with torticollis to be aware of?

Answer 12

suspected hip dysplasia, skull/facial asymmetries, atypical torticollis presentation, abnormal tone, late onset (6months or later), visual abnormalities, hx of acute onset

Question 13

How many severity levels are there in the classification of CMT?

Answer 13

7 levels, from early mild to late extreme

Question 14

What are the 5 components of first choice intervention for cmt?

Answer 14

neck prom, neck and trunk active rom, development of symmetrical movement, environmental adaptations. parent/caregiver education

Question 15

When should you refer for consultation when outcomes are not fully achieved (what outcome measures) when treating a child with torticollis?

Answer 15

asymmetries not resolving after 4-6 wks, only moderate resolution aftere 6 mo, infant older than 12 mo on initial exam,** 10-15 degrees** asymmetry persists b/w L and R sides, scm mass present on exam

Question 16

What are discharge criteria for CMT?

Answer 16

infant has full passive ROM w/in 5 degrees of non-affected side, symmetrical active movement patterns throughout the passive range, age appropriate motor development, no visible head tilt, parent/caregiver understanding of what to monitor

Question 17

How do you measure CMT?

Answer 17

standard goni, arthrodial goni, arom/prom: lateral flex and bilateral rotation in all fxnal positions, resting head/neck position in all fxnal positions

Question 18

t/f, you can do prom on a baby with cmt and a shunt in place

Answer 18

false, arom/aarom is okay but PROM is contraindicated

Question 19

What are some of the positioning holds for a child with cmt?

Answer 19

sidelying, prone, football hold

Question 20

Describe the proper head terms for each baby (from L to R)

Answer 20

normal, plagiocephaly, brachycephaly, scaphocephaly

Question 21

How do you measure plagiocephaly/brachycephaly (describe pictures)?

Answer 21

cranial vault asymmetry index on left and cephalic ratio on right (CVAI used more for plagiocephaly and cr for brachycephaly)