Torticollis Flashcards
what are the two MSK abnormalities that are more common than torticollis?
hip dislocation and torticollis
what are theories for the cause of torticollis?
direct injury to the muscle, infective myositis, hereditary, ischemia, birth trauma
what are risk factors for torticollis?
large birth weight, male, breech position, multiples, first childbirth, use of vacuum/forceps with delivery
what are the four bands of the SCM?
cleidomastoid, cleido-occipital, sterna-occipital, sternomastoid
What are the three classifications of CMT?
postural, congenital, mass
Which type of CMT is the most mild?
postural CMT
What is postural CMT?
presents as infant’s postural preference, absence of muscle PROM restrictions
What is congenital CMT?
SCM tightness, PROM and AROM limited
What is mass CMT?
fibrotic thickening of SCM, PROM and AROM limited, most severe form; tumor/fibroma that appears 2 weeks to 3 months after birth
decreased ROM caused by CMT
contralateral lateral flexion and ipsilateral rotation
facial and cranial changes caused by CMT
– asymmetry of craniofacial skeletal structures and jaw
– cupped, inferior/posterior positioned ear
– asymmetry of eyes (ipsilateral eye smaller)
– dental occlusion problems
– flattening of occiput
things that improve prognosis of CMT
– earlier identification
– postural CMT (compared to mass CMT)
– younger presentation/diagnosis
identifiable red flags in infants
– suspected hip dysplasia
– skull/facial asymmetries
– atypical torticollis presentation
– abnormal tone
– late onset (>6 mo)
– visual abnormalities
– history of acute onset
classifications of severity of CMT
early mild, early moderate, early severe
late mild, late moderate, late severe, late extreme
What are some things to examine during an eval for suspected CMT?
– motor development & synergies
– tolerance to position changes
– participation status (ask parent about positions during feeding, sleep, car seats, etc.)
five components for first-choice intervention for CMT
- neck PROM
- neck and trunk AROM
- development of symmetrical movement
- environmental adaptations
- parent education
when should you refer to physician while treating CMT?
– 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
contraindications for PROM
bony abnormalities, fracture, DS (AA instability), myelomeningocele, compromised CV or respiratory system, malignancy, osteomyelitis, TB, lax ligaments, infection, shunt, arnold-chiari malformation
what is the term for a head asymmetry?
plagiocephaly
what is the term for a deformity when the back of the head is wide and flat?
brachycephaly
what is the term for a deformity with a narrow head?
scaphocephaly
what are orthotics options for CMT?
hangar helmet, tot collar
what are two ways for measuring skull size?
cranial vault (diagonals) or dividing M/L by A/P
