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פידס > Torticollis > Flashcards

Torticollis Flashcards

1
Q

Torticollis

A

shortened SCM: lateral flexion to affected side: (name for side of head tilt)
rotation away from affected side

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2
Q

Types of Torticollis (5)

A
  1. congenital muscular torticollis (CMT)
  2. Ocular Torticollis
  3. Osseous Torticollis
  4. Neurologic Torticollis
  5. Sandifer’s Syndrome GERD
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3
Q

Congenital Muscular Torticollis

subtypes (4)

A
  1. Sternomastoid Tumor
  2. Muscular Torticollis
  3. Postural Torticollis
  4. Positional Preference
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4
Q

CMT subtype:

Sternomastoid Tumor

A

palpable SCM fibrous mass with tightness of SCM

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5
Q

CMT subtype:

Muscular Torticollis

A

no palpable tumor

tightness of SCM only

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6
Q

CMT subtype

Postural Torticollis

A

clinical features of CMT without SCM tumor and muscle tightness

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7
Q

CMT subtype

Positional Preference

A

infant spends too much time with head turned a particular way

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8
Q

CMT

  • what percent of infants with torticollis of congenital muscular torticollis?
  • how common in terms of muscular disorders
  • 4 conditions it is associated with
A

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

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9
Q

SCM Torticollis

  • cause
  • risk factors (6)

(I think she meant Sternomastoid Tumor)

A

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

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10
Q

Occular Torticollis

  • -what deficit
  • -type (2)
A

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

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11
Q

SUPERIOR OBLIQUE PALSY

A

: tilt head AWAY from the weak muscle: tilt head away from affected eye

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12
Q

LATERAL RECTUS PALSY:

A

head tilts TOWARDS affected eye

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13
Q

Osseous Torticollis

  • what is it
  • 2 causes
A

congenital vertebral anomalies:
presents with head tilt can can have associated cervicothoracic scoliosis

  1. hemivertibre vertebral foramen failure
  2. 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.

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14
Q

Developmental Delays with Torticollis

6

A

Infants with torticollis present with developmental delays

  1. decreased HEAD CONTROL
  2. limited VISUAL TRACKING
  3. limited REACHING on bent side (limited
    supination)
  4. preference ROLLING to only one side
  5. delayed SITTING
  6. asymmetrical WB (supine, prone, sitting, crawling)
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15
Q

Normal ROM

Rotation

A

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

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16
Q

Normal ROM

Lateral Flexion

A

65-75 degrees (70)

17
Q

chin to nipple:

A

40 degrees

18
Q

chin between nipple and shoulder:

A

70 degrees

19
Q

chin over shoulder:

A

90 degrees

20
Q

chin past shoulder:

A

100 degrees

21
Q

study scored 0-4 to see how high babies can hold head above the horizontal

2 months

10 months

A

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

22
Q

Torticollis Interventions

A

conservative management for first 12 MONTHS

  1. PROM, AAROM, AROM
  2. Postural Control Exercises
  3. strengthening
  4. caregiver instructions: positioning, feeding, carrying
  5. orthotic if needed

other

  • Tubular Orthosis for Torticollis
  • surgical release: indicated if deficits in rotation and lateral flexion more than 15 degrees
  • botox
23
Q

Rules for PROM in children with Torticollis

A

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

24
Q

Torticollis: carrying baby

A

to encourage head turn to unpreferred side

25
Q

Torticollis Play

A

toys: toys with sounds and lights to non preferred side

tummy time!!!!

visual tracking

horsey ride

26
Q

Torticollis Positioning

A

sidelying

midline orientation: car seat towel roll

27
Q

Torticollis Sleep

A

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

28
Q

Torticollis Sleeping

A

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
29
Q

TOT

A

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

30
Q

Recalcitrant Torticollis

A

(recalcitrant - uncooperative)

surgical release: indicated if deficit in rotation and lateral flexion of greater than 15 DEGREES

Botox

פידס (13 decks)

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