Torticollis

Question 1

is noticed within the first few days or weeks of life; presents as head tilt with or without rotation. A contracture of the sternocleidomastoid causes head tilt to the same side and rotation to the opposite side

Answer 1

Congenital torticollis

Question 2

contracture shown as tilt to right and rotation to left

Answer 2

Right torticollis

Question 3

most common type of torticollis

Answer 3

Congenital muscular torticollis

Question 4

Cause of torticollis:

Answer 4

• not known
• injury to SCM during birth → bleeding in SCM → compartment syndrome
• Faulty intruterine position

Question 5

________cases have tumor (fibrous mass) in the SCM most of which resolve within 4-6 months

Answer 5

1/3 of

Question 6

Associated anomalies with torticollis:

Answer 6

• Plagiocephaly (asymmterical flattening of the back of the head)
• Craniafacial asymmetry
• hemihypoplasia ( flattening of the cheek and
  elongation of vertical length of face)
• Scoliosis (cervical spine)
• Others: metatarsus adductus, clubfoot, calcaneovalgus, pes plannus, internal tibial torsion, brachial plexus injury

Question 7

Plagiocephaly, also known as

Answer 7

flat head syndrome

Question 8

Due to preferred position with tilt/rotation of head in torticollis, children can develop flattening of the posterior occiput on the contralateral side with asymmetry of shape of head. This is called?

Answer 8

Plagiocephaly

Question 9

With right side torticollis, which side will develop plagiocephaly?

Answer 9

left side

Question 10

Molding of skull in plagiocephaly occurs due to

Answer 10

lack of skeletal maturity

Question 11

In plagiocephaly need to rule out which other possible condition?

Answer 11

cranialsynostosis or premature closing of one of the cranial sutures

Question 12

American Academy of Pediatrics introduced “back to sleep program” implemented in 1992 to decrease risk of SIDS. What are two negative consequences of this program?

Answer 12

1. Now AAP found a 5 fold increase in
   plagiocephaly ( now occurs in 1 in 60 live
   births) and
2. later attainment of motor skills since back to sleep program implementation (less tummy time)

Question 13

Infants present with ______often unilateral related to
preferred rotation during supine sleeping

Answer 13

“bald spot”

Question 14

treatment of plagiocephaly

Answer 14

• parental education and physical therapy
  
  • Tummy time!
• if not effective: cranial helmet

Question 15

Torticollis, differential diagnosis:

Answer 15

• Congenital scoliosis
• Klippel-Feil syndrome (cervical vertebrae fussion)
• Benign Paroxysmal Torticollis:
  
  • Alternating (side) torticollis, worse in the AM, often self resolves in 1-3 years
  • Ataxia, vomiting
• *Ocular torticollis: superio oblique muscle palsy
• *Sandifer syndrome (Reflux with hiatal hernia)
• *Gastroesophegeal reflux
  
  • ​Posturing of head and neck due to pain
• *Other neuromuscular disorders such as CP or Arnold Chiari malformation

Question 16

Klippel-Feil syndrome

Answer 16

is a bone disorder characterized by the abnormal joining (fusion) of two or more spinal cervical vertebrae

Question 17

Assessment of torticollis:

Answer 17

• Cervical ROM & AROM (have them track)
• Funtion strenght
• Rightingh reactions
• Equilibrium reactions
• Visual tracking

Question 18

A child is only able to bring the chin to nipple (rotation):

Answer 18

40 deg

(normal is 100-120 deg)

Question 19

A child is only able to bring the chin bet nipple and shoulder (rotation):

Answer 19

70 deg

Question 20

General guidelines for ROM of neck rotation using the nipple as reference:

Answer 20

• Chin to nipple = 40
• Chin between nipple and shoulder = 70
• Chin over the shoulder = 90
• Chin past shoulder = 100

Question 22

Focus on daily __________when young can have good results with up to 90% recovering

Answer 22

stretching

Question 23

Torticollis Treatment

Answer 23

Usually conservative:

• Physical Therapy
• Massage Therapy
• Muscle Taping
• Bracing - TOT collar
• Botox Injection
• Myofascial release
• Craniosacral therapy
• Surgery less common, performed if above unsuccessful

Question 24

Torticollis treatment; Positioning and stretching must be incorporated into daily routine. How many?

Answer 24

• short bouts 3-5 minutes throughout the day to total about 1 hour of exercise

Question 27

Carrying tips fro children with torticollis:

Answer 27

• Carry child on ipsilateral hip so when parent talks
  child will have to rotate neck to the involved side
• Carry in sideling for righting of head to opposite side
  ( can also stretch while in this position)

Question 29

Treatment visits by PT should gradually decrease as parents become effective in implementing therapy activities:

Answer 29

• One a week
• Reduce to every other week
• Reduce to once a month

Question 31

This torticollis orthosis consists of PVC tubing with 2 struts placed on affected side to limit head tilt

Answer 31

Tubular Orthosis of Torticollis (TOT collar)

Question 32

Answer 32

Tubular Orthosis of Torticollis (TOT collar)

Question 33

Tubular Orthosis of Torticollis (TOT) collar can be worn by infants with torticollis that are______ or older

Answer 33

4 months

Question 34

Pre-requisites for wearing a a TOT:

Answer 34

Child should have consistent head tilt of at least 5-10
degrees and have righting responses to lift head off the
collar

Question 35

dosage of TOT

Answer 35

• 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 in car seat

Question 36

when is torticollis surgery indicated?

Answer 36

• Usually indicated when child has undergone at least 6 months of therapy and 1 year of age
• Has shown progressive head asymmetry
• ROM limitations of greater than 15 degrees