Torticollis Flashcards
Torticollis
shortened SCM: lateral flexion to affected side: (name for side of head tilt)
rotation away from affected side
Types of Torticollis (5)
- congenital muscular torticollis (CMT)
- Ocular Torticollis
- Osseous Torticollis
- Neurologic Torticollis
- Sandifer’s Syndrome GERD
Congenital Muscular Torticollis
subtypes (4)
- Sternomastoid Tumor
- Muscular Torticollis
- Postural Torticollis
- Positional Preference
CMT subtype:
Sternomastoid Tumor
palpable SCM fibrous mass with tightness of SCM
CMT subtype:
Muscular Torticollis
no palpable tumor
tightness of SCM only
CMT subtype
Postural Torticollis
clinical features of CMT without SCM tumor and muscle tightness
CMT subtype
Positional Preference
infant spends too much time with head turned a particular way
CMT
- what percent of infants with torticollis of congenital muscular torticollis?
- how common in terms of muscular disorders
- 4 conditions it is associated with
more than 80% of infants with torticollis have CMT
third most common infant congenital musculoskeletal disorder after hip dislocation and clubfoot
associated with
1) plagiocephaly
2) congenital hip dislocations
3) club foot
4) hiking of shoulder on the affected side
SCM Torticollis
- cause
- risk factors (6)
(I think she meant Sternomastoid Tumor)
SCM non tender fibrous palpable tumor
CAUSE: head neck position in utero or during labor and delivery
RISK FACTORS: (same as for plagiocephaly)
1) first born
2) large birth weight
3) multiple births
4) breech (abnormal positioning (such as being in the breech position, where the baby’s buttocks face the birth canal)
5) forceps or vacuum delivery
6) uterine abnormalities
Occular Torticollis
- -what deficit
- -type (2)
may present with sign of torticollis without cervical ROM deficits
The tilting of the head allows for better alignment of the eyes, sometimes aiding in RELIEF OF DIPLOPIA and promotes BINOCULAR VISION
**Child with head tilt should be evaluated by ophthalmologist
Types occular muscle palsy:
–SUPERIOR OBLIQUE PALSY: tilt head AWAY from the weak muscle: tilt head away from affected eye
–LATERAL RECTUS PALSY: head tilts TOWARDS affected eye
SUPERIOR OBLIQUE PALSY
: tilt head AWAY from the weak muscle: tilt head away from affected eye
LATERAL RECTUS PALSY:
head tilts TOWARDS affected eye
Osseous Torticollis
- what is it
- 2 causes
congenital vertebral anomalies:
presents with head tilt can can have associated cervicothoracic scoliosis
- hemivertibre vertebral foramen failure
- Klippel-Feil syndrome segmentation failure
Absence of a palpable contracture of the sternocleidomastoid should alert the examiner to the possibility of an underlying osseous problem.
Developmental Delays with Torticollis
6
Infants with torticollis present with developmental delays
- decreased HEAD CONTROL
- limited VISUAL TRACKING
- limited REACHING on bent side (limited
supination) - preference ROLLING to only one side
- delayed SITTING
- asymmetrical WB (supine, prone, sitting, crawling)
Normal ROM
Rotation
100-120 degrees (110)
chin to nipple: 40 degrees
chin between nipple and shoulder: 70 degrees
chin over shoulder: 90 degrees
chin past shoulder: 100 degrees
Normal ROM
Lateral Flexion
65-75 degrees (70)
chin to nipple:
40 degrees
chin between nipple and shoulder:
70 degrees
chin over shoulder:
90 degrees
chin past shoulder:
100 degrees
study scored 0-4 to see how high babies can hold head above the horizontal
2 months
10 months
0: head below horizontal
1: head at horizontal
2: hold head slightly over horizontal
3: hold head high over horizontal
4: hold head very high over horizontal
at two months old normal infants could hold head at horizontal
most ten months old could do head righting high or very high over the horizontal
Torticollis Interventions
conservative management for first 12 MONTHS
- PROM, AAROM, AROM
- Postural Control Exercises
- strengthening
- caregiver instructions: positioning, feeding, carrying
- orthotic if needed
other
- Tubular Orthosis for Torticollis
- surgical release: indicated if deficits in rotation and lateral flexion more than 15 degrees
- botox
Rules for PROM in children with Torticollis
shouldnt be done with an infant who is actively resisting stretch
rotation hands at the head, stabilize at the shoulder
STRETCH
3-5 reps
7-10x/day
passive stretching exercises can be upsetting for infants, causing pain and in some cases infants resist strongly
Torticollis: carrying baby
to encourage head turn to unpreferred side
Torticollis Play
toys: toys with sounds and lights to non preferred side
tummy time!!!!
visual tracking
horsey ride
Torticollis Positioning
sidelying
midline orientation: car seat towel roll
Torticollis Sleep
change baby sleeping position by: alternate child direction in crib: ie baby head at top of crib one night and towards bottom the next night
place infant to sleep with head to one side for a night and then turn it to the other side the next night
once baby is asleep gently move head to non preferred side
try placing a mobile on the side of the crib or playpen to encourage baby to look in that direction
Torticollis Sleeping
Bottle
- offer bottle to the side opposite preferred rotation
- parent/caregiver alternate arms for feeding
BREASTFEEDING
-difficult-prefers to nurse to one side
- for example an infant who prefers to rotate head right:
- —left breast cradle hold
- —right breast football hold
TOT
Tubular Orthosis for Torticollis
INDICATION:
- 4 months of age with a 5 degree head tilt
- must be able to laterally flex away from the affected side – exhibit head control
USE WHEN AWAKE AND SUPERVISED
-initial wear schedule 30 minutes and check for redness
increase wear time as tolerated until it can be worn for all waking hours
-wear time can be decreased when tilt less than 5 DEGREES CONSISTENTLY
***not to be used in the car seat
Recalcitrant Torticollis
(recalcitrant - uncooperative)
surgical release: indicated if deficit in rotation and lateral flexion of greater than 15 DEGREES
Botox
