Torticollis

Question 1

what are the two MSK abnormalities that are more common than torticollis?

Answer 1

hip dislocation and torticollis

Question 2

what are theories for the cause of torticollis?

Answer 2

direct injury to the muscle, infective myositis, hereditary, ischemia, birth trauma

Question 3

what are risk factors for torticollis?

Answer 3

large birth weight, male, breech position, multiples, first childbirth, use of vacuum/forceps with delivery

Question 4

what are the four bands of the SCM?

Answer 4

cleidomastoid, cleido-occipital, sterna-occipital, sternomastoid

Question 5

What are the three classifications of CMT?

Answer 5

postural, congenital, mass

Question 6

Which type of CMT is the most mild?

Answer 6

postural CMT

Question 7

What is postural CMT?

Answer 7

presents as infant’s postural preference, absence of muscle PROM restrictions

Question 8

What is congenital CMT?

Answer 8

SCM tightness, PROM and AROM limited

Question 9

What is mass CMT?

Answer 9

fibrotic thickening of SCM, PROM and AROM limited, most severe form; tumor/fibroma that appears 2 weeks to 3 months after birth

Question 10

decreased ROM caused by CMT

Answer 10

contralateral lateral flexion and ipsilateral rotation

Question 11

facial and cranial changes caused by CMT

Answer 11

– asymmetry of craniofacial skeletal structures and jaw
– cupped, inferior/posterior positioned ear
– asymmetry of eyes (ipsilateral eye smaller)
– dental occlusion problems
– flattening of occiput

Question 12

things that improve prognosis of CMT

Answer 12

– earlier identification
– postural CMT (compared to mass CMT)
– younger presentation/diagnosis

Question 13

identifiable red flags in infants

Answer 13

– suspected hip dysplasia
– skull/facial asymmetries
– atypical torticollis presentation
– abnormal tone
– late onset (>6 mo)
– visual abnormalities
– history of acute onset

Question 14

classifications of severity of CMT

Answer 14

early mild, early moderate, early severe
late mild, late moderate, late severe, late extreme

Question 15

What are some things to examine during an eval for suspected CMT?

Answer 15

– motor development & synergies
– tolerance to position changes
– participation status (ask parent about positions during feeding, sleep, car seats, etc.)

Question 16

five components for first-choice intervention for CMT

Answer 16

1. neck PROM
2. neck and trunk AROM
3. development of symmetrical movement
4. environmental adaptations
5. parent education

Question 17

when should you refer to physician while treating CMT?

Answer 17

– asymmetries not resolving after 4-6 weeks
– only moderate resolution after 6 months of tx
– infant older than 12 months at initial eval
– 10-15 degrees asymmetry persists between R and L
– SCM mass present on initial exam

Question 18

contraindications for PROM

Answer 18

bony abnormalities, fracture, DS (AA instability), myelomeningocele, compromised CV or respiratory system, malignancy, osteomyelitis, TB, lax ligaments, infection, shunt, arnold-chiari malformation

Question 19

what is the term for a head asymmetry?

Answer 19

plagiocephaly

Question 20

what is the term for a deformity when the back of the head is wide and flat?

Answer 20

brachycephaly

Question 21

what is the term for a deformity with a narrow head?

Answer 21

scaphocephaly

Question 22

what are orthotics options for CMT?

Answer 22

hangar helmet, tot collar

Question 23

what are two ways for measuring skull size?

Answer 23

cranial vault (diagonals) or dividing M/L by A/P