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Peds > Torticollis > Flashcards

Torticollis Flashcards

1
Q

Congenital mm torticollis

A

Most common type

3rd most common congenital musculoskeletal anomaly

Boys and girls equally affected

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2
Q

Causes

A

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

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3
Q

Associated Anomalies

A 
Plagiocephaly
Craniofacial asymmetry
Hemihypoplasia
Scoliosis
Others
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4
Q

Craniofacial asymmetry

A

Flattening of face and downward displacements of eye, ear, and mouth

May be related to prone positioning with preferred head rotation

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5
Q

Hemihypoplasia

A

Flattening of the cheek and elongation of vertical length of face

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6
Q

Others

A

Metatarsus adductus

Clubfoot

Calcaneovalgus

Pes plannus

Internal tibial torsion

BPI

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7
Q

Plagiocephaly

A

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

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8
Q

Cranialsynostosis

A

Premature closing of one of cranial suture

Need to rule this out in torticolis

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9
Q

Congenital scoliosis

A

Some recommend all children have c-spine xray prior to tx to rule this out

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10
Q

Klippel-Feil syndrome

A

Congenital syndrome with 1 or more cervical vertebrae are fused

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11
Q

Benign Paroxysmal Torticolis

A

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

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12
Q

Ocular torticollis

A

Superior oblique mm palsy

Contracture of SCM not seen at first, but developed as a result of faulty head posture related to vision

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13
Q

Sandifer syndrome

A

Reflux with hiatal hernia

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14
Q

Gastroesophegeal reflux

A

Posturing of head and neck due to pain

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15
Q

Other neuromm disorders

A

CP

Arnold Chiari malformation

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16
Q

Assessment

A 
Cervical ROM
Functional strength
Righting rxns
Equilibrium rxns
Visual tracking
17
Q

Normal ROM neck rotation

A

100-120

18
Q

Chin to nipple

A

40

19
Q

Chin between nipple and shoulder

A

70

20
Q

Chin over shoulder

A

90

21
Q

Chin past shoulder

A

100

22
Q

Treatment

A

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

23
Q

Carrying Tips

A

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)

24
Q

SCM contracture

A

Ipsilateral SB
Contralateral rotation

Can have just one or both components

25
Q

Tubular Orthosis of Torticollis (TOT collar)

A

Consists of PVC tubing with 2 struts placed on affected side to limit head tilt

Thought to work by changing child’s concept of normal head posture by putting head in neutral for appropriate visual and vestibular input

26
Q

TOT collar guidelines

A

Infants 4+ mos

Consistent head tilt of at least 5-10 degrees

Begin with 30 min of wearing and checking for red marks

Increase wearing time to WAKING hours of the day

Should not be worn when infant not attended to or when napping or when in car seat

D/C use when tilt less than 5 degrees

27
Q

Surgery

A

Indicated after 6 mos therapy and 1 year of age

Has shown progressive head asymmetry

ROM limitations of greater than 15 degrees

Open tenotomy of the SCM

Followed by casting or brace or collar with lateral bend to opposite side for several mos

Follow by PT

28
Q

Older child with CMT

A

Surgical approach

At times BOTH ends of SCM will be lengthened

Removable brace post-op for stretching to be implemented with few days post-op

29
Q

CPG

A

ID newborns at risk for CMT

Document hx

Screen infant

Refer to MD if red flags are identified within weeks of tx

30
Q

Red flags

A

Poor visual tracking

Abnormal mm tone

Unusual asymmetries

31
Q

Slides to Go Over

A

Slide 36 and 37

Peds (25 decks)

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