Torticollis Flashcards
Congenital mm torticollis
Most common type
3rd most common congenital musculoskeletal anomaly
Boys and girls equally affected
Causes
Not fully understood but thought to be related to difficulty in delivery
Possible compartment syndrome from SCM during birthing process
Tumor in SCM
Fibrous tissue in SCM
Associated Anomalies
Plagiocephaly Craniofacial asymmetry Hemihypoplasia Scoliosis Others
Craniofacial asymmetry
Flattening of face and downward displacements of eye, ear, and mouth
May be related to prone positioning with preferred head rotation
Hemihypoplasia
Flattening of the cheek and elongation of vertical length of face
Others
Metatarsus adductus
Clubfoot
Calcaneovalgus
Pes plannus
Internal tibial torsion
BPI
Plagiocephaly
Due to preferred position with tilt/rotation of head (lateral flexion to ipsilat side and rotation to contralat side) can develop flattening of the posterior occiput on the contralat side with asymmetry of shape of head
Molding of skull occurs due to lack of skeletal maturity
Compounded by “back to sleep” initiative
Parallelogram
Helmets recommended
TUMMY TIME
Cranialsynostosis
Premature closing of one of cranial suture
Need to rule this out in torticolis
Congenital scoliosis
Some recommend all children have c-spine xray prior to tx to rule this out
Klippel-Feil syndrome
Congenital syndrome with 1 or more cervical vertebrae are fused
Benign Paroxysmal Torticolis
Alternating torticolis
Worse in am
Resolves in 1-3 years
Vomiting, ataxia, pallor, and irritability
Etiology unknown but thought to be related to cerebellar dysfunction
Ocular torticollis
Superior oblique mm palsy
Contracture of SCM not seen at first, but developed as a result of faulty head posture related to vision
Sandifer syndrome
Reflux with hiatal hernia
Gastroesophegeal reflux
Posturing of head and neck due to pain
Other neuromm disorders
CP
Arnold Chiari malformation
Assessment
Cervical ROM Functional strength Righting rxns Equilibrium rxns Visual tracking
Normal ROM neck rotation
100-120
Chin to nipple
40
Chin between nipple and shoulder
70
Chin over shoulder
90
Chin past shoulder
100
Treatment
Early recognition and tx IMPERATIVE
Focus on daily stretching when young…can have good results with up to 90% recovering
Delayed treatment results in further tightening and stiffening of SCM and potential for need for surgical intervention
Carrying Tips
Carry child on ipsilat hip so when parent talks to child, the child will have to rotate neck to the involved side
Carry in side-lying for righting of head to opposite side (can also stretch while in this position)
SCM contracture
Ipsilateral SB
Contralateral rotation
Can have just one or both components
