Torticollis Flashcards by Colleen Caribardi

(true/false) Torticollis may be a clinical sign of one of a variety of underlying pathologies, some benign and some quite serious

true

How well did you know this?

Not at all

Perfectly

What does an infants positioning look like if they have L sided torticollis?

R ROT and SB

How well did you know this?

Not at all

Perfectly

Torticollis occurs in every 1 and ___ newborns.

1 in 6

How well did you know this?

Not at all

Perfectly

What population is torticollis more frequent?

White males and infants exposed to opioids in utero

First born infants

How well did you know this?

Not at all

Perfectly

80-90% of torticollis cases also has what condition?

plagiocephaly

How well did you know this?

Not at all

Perfectly

What sided torticollis is more common?

Left

How well did you know this?

Not at all

Perfectly

Most torticollis cases are identified by when?

3 months

How well did you know this?

Not at all

Perfectly

What are the origins of torticollis? Which is more common?

muscular (80%)
non-muscular

How well did you know this?

Not at all

Perfectly

What developmental disorders commonly have torticollis due to asymmetry?

CP, down syndrome, and myelomeningocele

How well did you know this?

Not at all

Perfectly

(true/false) it is common to see a sudden onset of torticollis within the first year.

FALSE

How well did you know this?

Not at all

Perfectly

definition: describes the posture of the head and neck from unilateral shortening of the sternocleidomastoid (SCM) muscle, causing the head to tilt toward and rotate away from the affected SCM muscle.

congenital muscular torticollis

How well did you know this?

Not at all

Perfectly

What are the sutypes of congenital muscular torticollis?

postural
muscular
SCM mass

How well did you know this?

Not at all

Perfectly

What are the characteristics of postural congenital muscular torticollis?

has a postural preference
NO muscular or PROM restrictions

How well did you know this?

Not at all

Perfectly

What is the mildest form of congenital muscular torticollis?

postural

How well did you know this?

Not at all

Perfectly

What are the characteristics of congenital muscular torticollis with a SCM mass?

Fibrotic thickening of the SCM
PROM limitations

How well did you know this?

Not at all

Perfectly

What is the most severe type of congenital muscular torticollis?

SCM mass

How well did you know this?

Not at all

Perfectly

What are the forms of postnatal muscular torticollis?

environmental-induced
plagiocephaly- induced
positional preference-induced

How well did you know this?

Not at all

Perfectly

What are the etiologies of congenital muscular torticollis?

ischemia to the muscle belly
birth trauma
intrauterine malposition leading to compartment syndrome

How well did you know this?

Not at all

Perfectly

(smaller/larger) babies are more likely to develop torticollis

larger

(true/false) Fetal position in utero may injure the SCM, leading to a compartment syndrome. The MOI in congenital muscular torticollis cases is therefore a kink or crush with subsequent ischemia

true

What are risk factors for torticollis?

large birth weight
male
breech position
multiple pregnancies
primiparous mother
difficult labor/delivery
vacuum/forceps
nuchal cord
uterine abnormalities

What are the causes of non-muscular torticollis?

Skeletal malformation - klippel-feil syndrome
neurologic - brachial plexus injury
ocular lesion
sandifer syndrome
benign paroxysmal torticollis
dystonia
pathology of the posterior fossa
postenecephalitis syndromes
arnold-chiari malformation
syringomyelia

What can be the first sign of an ocular deficit?

torticollis

What is sprengel’s deformity?

a condition where the scapula (shoulder blade) on one or both sides are underdeveloped (hypoplastic) and abnormally high. It is due to failure of descent of the scapula during embryonic development from its position in the neck to its normal position in the posterior thorax

What is klippel-feil syndrome?

rare disorder characterized by the congenital fusion of any 2 of the 7 cervical (neck) vertebrae. ## Footnote --> It is caused by a failure in the normal segmentation or division of the cervical vertebrae during the early weeks of fetal development. -->The most common signs of the disorder are short neck, low hairline at the back of the head, and restricted mobility of the upper spine

What is sandifer syndrome?

involves spasmodic torsional dystonia with arching of the back and rigid opisthotonic posturing, mainly involving the neck, back, and upper extremities, associated with symptomatic gastroesophageal reflux, esophagitis, or the presence of hiatal hernia

What can benign paroxysmal torticollis be related to?

infant migraines or vestibular dysfunction

What are secondary impairments of torticollis?

- plagiocephaly/cranial deformation - facial deformation - compensatory scoliosis (Cx and T-spine) - metatarsus adductus - GERD - developmental hip dysplasia

What does facial deformations caused by torticollis look like?

- flattening of the affected side - downward displacement of eye, ear, and mouth

(true/false) GERD is common in infants with torticollis

true --> can be due to tongue and lip ties

(true/false) Infants who spent 3 periods of awake time in prone has significantly lower AIMS scores

FALSE (higher score)

What are reasons for referral?

- Suspected hip dysplasia - Skull or facial asymmetry - Atypical presentation - Abnormal tone - Late onset torticollis at 6 months or older - Visual abnormalities - Acute onset - Changes in color when screening neck PROM - >12 months at initial screen and either facial asymmetry and/or 10-15 degree difference in AROM/PROM - >7 months at initial screen and has SCM mass

What outcome measures can you use on infants with torticollis?

AIMS, TIMP, PDMS-2

What are contraindications for PROM to treat torticollis?

- Bony abnormalities - Fracture - Down syndrome - Myelomeningocele - Compromised circulatory or respiratory system - Malignancy - Osteomyelitis - Tuberculosis - Ruptures or lax ligaments - Infection - Shunt - Arnold-Chiari malformation

If interventions are started before one full month of having torticollis, 98% will achieve PROM by ____ months.

1.5 months

If interventions to treat torticollis are started after 1 month of onset, it can take up to __ months to treat.

6 months

If interventions for torticollis are started after 6 months of onset, it required ____ months of care.

9-10 months

PROM is tolerated better in (younger/older) infants with torticollis

younger

What are stretching parameters to treat torticollis?

one 30 second hold rep at end range passive stretch 4x/day

Infants with torticollis should have prone play for > ___ hour/day

1 hour

(true/false) you want to maximize time in a car seat/carrier if an infant has GERD

FALSE

Those with torticollis who are treated prior to ___ months has 100% resolution of symptoms

3 months

What are prognostic indicators for a longer treatment duration?

- low birth weight - breech presentation - motor asymmetry

What intervention helps improve outcomes?

increased stretching frequency

When is surgery indicated for torticollis?

Indicated if torticollis has not resolved by 12 months; significant loss of ROM; severe plagiocephaly

What is a ToT collar used for?

for infants with torticollis that is unresolving

What is the optimal age range for helmets? how long should they be work?

4-8 months 23 hrs/day for 7 days/wk