Torticollis Flashcards
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
Congenital torticollis
contracture shown as tilt to right and rotation to left
Right torticollis
most common type of torticollis
Congenital muscular torticollis
Cause of torticollis:
- not known
- injury to SCM during birth → bleeding in SCM → compartment syndrome
- Faulty intruterine position
________cases have tumor (fibrous mass) in the SCM most of which resolve within 4-6 months
1/3 of
Associated anomalies with torticollis:
- 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
Plagiocephaly, also known as
flat head syndrome
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?
Plagiocephaly
With right side torticollis, which side will develop plagiocephaly?
left side
Molding of skull in plagiocephaly occurs due to
lack of skeletal maturity
In plagiocephaly need to rule out which other possible condition?
cranialsynostosis or premature closing of one of the cranial sutures
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?
- Now AAP found a 5 fold increase in
plagiocephaly ( now occurs in 1 in 60 live
births) and - later attainment of motor skills since back to sleep program implementation (less tummy time)
Infants present with ______often unilateral related to
preferred rotation during supine sleeping
“bald spot”
treatment of plagiocephaly
- parental education and physical therapy
- Tummy time!
- if not effective: cranial helmet
Torticollis, differential diagnosis:
- 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
Klippel-Feil syndrome
is a bone disorder characterized by the abnormal joining (fusion) of two or more spinal cervical vertebrae
Assessment of torticollis:
- Cervical ROM & AROM (have them track)
- Funtion strenght
- Rightingh reactions
- Equilibrium reactions
- Visual tracking
A child is only able to bring the chin to nipple (rotation):
40 deg
(normal is 100-120 deg)
A child is only able to bring the chin bet nipple and shoulder (rotation):
70 deg
General guidelines for ROM of neck rotation using the nipple as reference:
- Chin to nipple = 40
- Chin between nipple and shoulder = 70
- Chin over the shoulder = 90
- Chin past shoulder = 100
Focus on daily __________when young can have good results with up to 90% recovering
stretching
Torticollis Treatment
Usually conservative:
- Physical Therapy
- Massage Therapy
- Muscle Taping
- Bracing - TOT collar
- Botox Injection
- Myofascial release
- Craniosacral therapy
- Surgery less common, performed if above unsuccessful
Torticollis treatment; Positioning and stretching must be incorporated into daily routine. How many?
- short bouts 3-5 minutes throughout the day to total about 1 hour of exercise
Carrying tips fro children with torticollis:
- 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)
Treatment visits by PT should gradually decrease as parents become effective in implementing therapy activities:
- One a week
- Reduce to every other week
- Reduce to once a month
This torticollis orthosis consists of PVC tubing with 2 struts placed on affected side to limit head tilt
Tubular Orthosis of Torticollis (TOT collar)
Tubular Orthosis of Torticollis (TOT collar)
Tubular Orthosis of Torticollis (TOT) collar can be worn by infants with torticollis that are______ or older
4 months
Pre-requisites for wearing a a TOT:
Child should have consistent head tilt of at least 5-10
degrees and have righting responses to lift head off the
collar
dosage of TOT
- 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
when is torticollis surgery indicated?
- 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
