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MSK 3 final > torticollis > Flashcards

torticollis Flashcards

1
Q

definition of CMT

A

a postural deformity evident shortly after birth, typically presenting as side bending of the neck to one side and head/chin rotation to opposite side

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2
Q

cause of CMT

A

shortening of SCM muscle and may be accompanied by other MSK or neuro conditions

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3
Q

right sided torticollis

A

right SB
left rotation
tight R SCM

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4
Q

incidence

A

as many as 16% of newborns (1 in 6) experience torticollis

more prevalent in males, with ratio of 3:2

CMT frequently accompanied with cranial deformation

15% of babies with CMT also have hip dysplasia

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5
Q

3 types of CMT

A

postural
muscular
SCM MASS

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6
Q

postural CMT

A

the infant exhibits a postural preference WITHOUT muscle tightness or restriction to PROM

mildest form

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7
Q

muscular CMT

A

characterized by tightness of the SCM muscle and limitation of PROM

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8
Q

SCM mass

A

presents with thickening of the SCM muscle and restricted PROM

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9
Q

etiology of CMT - prenatal factors

A

longer body length

intrauterine crowding

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10
Q

etiology of CMT - perinatal factors

A

birth trauma

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11
Q

etiology CMT - post natal factors

A

positional preference
containers
GI reflux

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12
Q

prognosis - referral before 1 month

A

98% of infants achieve near normal range within 1.5 months

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13
Q

prognosis w referral between 1-6mos

A

prolongs intervention to about 6 months

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14
Q

prognosis referral after 6 months

A

requires 9+ months of interventions with fewwer infants achieving near normal range

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15
Q

possible complications if untreated

A

trouble bringing hands to midline

delayed visual development and visual tracking

problems w motor planning

decreased protective responses on affected side

asymmetrical motor skills and transitional movements

cranial deformation

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16
Q

ket takeaways

A

named by side of tight muscle

frequently accompanied with cranial deformation

early diagnosis is key

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17
Q

family interview - history

A

Age at initial visit (chronological and corrected age)
* Age of onset of symptoms
* Pregnancy history including maternal sense of whether the baby was “stuck” in one
position during the final 6 weeks of pregnancy
* Delivery history including birth presentation (cephalic or breech); use of assistance
during delivery such as forceps or vacuum suction
* Head posture/preference and changes in the head/face
* Family history of torticollis or any other congenital or developmental conditions
* Other known or suspected medical conditions
* Developmental milestones appropriate for age

18
Q

family interview - routines

A

feeding
sleeping
tummy time
time in equipemnt/devices
daycare/sitter

19
Q

posture and positioning - supine

A

Document the side of
torticollis, asymmetrical
hip, trunk, and extremity
positions, facial and skull
asymmetries, restricted
AROM

20
Q

prone posture

A

Document asymmetry of
the spine, the head on
the trunk, asymmetrical
use of the extremities,
and the infant’s tolerance

21
Q

supported upright positions posture

A

Document asymmetrical
preferential postures and
compensations in the
shoulders, trunk, and hip

22
Q

sidelying posture

A

Document asymmetries,
trunk flexion or
extension, head lifting,
leg position

23
Q

bilateral AROM - cervical rot and lateral flexion

A

Assess in supine and supported upright if age
appropriate
* Asymmetrical and compensatory movements
can indicate muscle tightness, restrictions or
weakness
* Treatment to improve AROM consistent with
goals of early intervention

24
Q

bilateral PROM - cervical rot and lateral flexion

A

Severity of CMT determined by difference between left and right PROM measures of
cervical rotation
* Normal value passive cervical rotation for child < 12 months: 110 ± 6 degrees
* Normal value passive lateral flexion for child < 12 months: 70 ± 2.4 degrees

25
Q

bilateral AROM/PROM - UE anD LE

A

Document infant’s natural movements
* Passively move arms and legs through all available range at each joint
* Passively move ribs and spine
* Rule out:
* Developmental dysplasia of hip (DDH): observe for symmetry and stability of hip, leg
length symmetry, gluteal skin folds, hip scour test, Barlow and Ortolani Maneuvers
* Brachial plexus injuries or clavicle fractures
* Neurological impairments
* Hypermobility
* CNS lesions
* Scoliosis

26
Q

pain or discomfort

A

Document any behaviors reflective of
discomfort, or pain reactions in the infant
and child during the examination process
* Pain is not typically associated with the
initial presentation of CMT
* The FLACC is recommended to document
baseline status
* The PT should work with the parents and
caregivers to differentiate actual pain
responses from discomfort or behavioral
reactions to stretching, anxiety, or the
stress of an unusual environment.

27
Q

skin integrity

A

Document skin integrity
* Symmetry of neck and hip skin folds
* Presence and location of SCM mass
* Size, shape and elasticity of SCM muscle and secondary muscles

28
Q

craniofacial asymmetries and head/skull shape

A

Up to 90% of infants with CMT will also have
craniofacial asymmetry
* Document cranial deformities, including
plagiocephaly, brachycephaly, and
dolichocephaly
* Craniofacial asymmetries on the side of the
torticollis may include:
* smaller and elevated eye with changes in the orbit
* recession of the ipsilateral ear
* a reduced jaw height with malocclusion
* possible gum line asymmetry

29
Q

cranial deformation

A

plagiocephaly
brachycephaly
dolichocephaly

30
Q

plagiocephaly

A

most common type of infant flat head syndrome. Generally, the back of the baby’s head
is flat on one side.

31
Q

brachycephaly

A

second most common type of flat head syndrome. The back of the head is flattened
instead of curved.

32
Q

dolichocephaly

A

less common type of flat head synfrome
head is flattened on both sides

33
Q

craniosynostosis vs plagiocephaly

A

Premature closure of one or more cranial sutures
* Prevalence ranges from 0.4% to 0.07%
* Requires referral to neurosurgery

34
Q

gross motor function

A

Test of Infant Motor Performance (TIMP): 0-4 months
* Alberta Infant Motor Scale (AIMS): 0-18 months
* Peabody Developmental Motor Scales (PDMS-2): 0-5 years

35
Q

muscle function scale

A

0 = head below horizontal line
1 = head on the horizontal line
2 = slightly above line
3 = high above line but below 45dg
4 = head high above and more than 45 dg
5 = head very high almost vertical

36
Q

treatment - first choice

A

Neck PROM – Gentle stretching. Should not be painful to baby and stopped if infant resists or parent
perceives changes in breathing or circulation. Each cheek on caregiver’s chest or floor.

Neck & Trunk AROM – Exciting things to the non-preferred side. Tummy time, short spurts, total > 1hr/day.

Symmetrical Movement Development – Both sides, both ways. Sidelying, rolling, reaching. Want bend and
twist, not arching.

Environmental Adaptations – Carry baby vs keeping them in holders, use towel rolls inside of swing or
holder

Parent/Caregiver Education – Alternate sides for holding, feeding and changing diaper

37
Q

discharge criteria

A

PROM within 5 dg of non affected side

symmestrical active movement patterns

age appropriate motor development

no visible head tilt

parents understand what to monitor in growth

38
Q

re eval should include

A

positional preference
symmetry of movement
developmental milestones

39
Q

consult primary care

A

When asymmetries of the head, neck, and trunk are not starting to resolve after 4-6
weeks of comprehensive intervention.
2. After 6 months of treatment with a plateau in resolution

40
Q

cranial reshaping helmet

A

head shaping not improving with positioning
4-10 months old
length depends on severity

41
Q

key takeaways

A

Key Takeaways
1) Examination includes infant history, routines, body structures/posture,
strength and mobility
2)Use decision tree to classify severity level
3) Follow first choice interventions
4)Use discharge criteria for developing goals and plan of care

MSK 3 final (7 decks)

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