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Torticollis Flashcards

1
Q

Torticollis describes

A

A posture, not a dx

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2
Q

Torticollis

A

Lateral tilt to one side, rotation to opposite side

Named for tilt

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3
Q

1 in 5 children w/ torticollis have a ____ etiology

A

Non muscular

Diff dx include hx, physical exam, imaging

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4
Q

Acquired torticollis

A

Traumatic or non traumatic

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5
Q

Congenital torticollis

A

Postural

Congenital muscular torticollis

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6
Q

Acquired traumatic torticollis

A

Soft tissue injury
Fracture neck/clavicle —> spasm, BPI
AA rotation subluxation due to injury

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7
Q

Acquired non traumatic torticollis - inflammation

A 
Inflammation conditions causing rotary subluxation of C1 on C2 including:
Osteomyelitis of Cspine
Juvenille RA
Tonsillitis 
Mastoidits
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8
Q

Acquired non traumatic torticollis - ocular

A

Oculomotor weakness or ocular lesion
Sup oblique palsy
Congenital nystagmus of diplopia

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9
Q

Acquired non traumatic torticollis - neuro

A

Account for 10% non muscular torticollis
Tumors most common
Arnold-chiari malformation

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10
Q

Acquired non traumatic torticollis - bony deformities

A

Fusion of 1 or more cervical vert

Hemivertebrae

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11
Q

Acquired non traumatic torticollis - BPT

A

Benign paroxysmal torticollis
Side of tilt alters
Etio UK, suspect neuro
Typically resolved by 3-5 yrs w/out tx

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12
Q

Acquired non traumatic torticollis - sandier syndrome

A

Hiatal hernia and or GERD causes posturing of head to decrease pain of esophagitis

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13
Q

Acquired non traumatic torticollis - causes

A 
Inflammation
Oculomotor
Neurological
Bony deformity
BPT
Sandier syndrome
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14
Q

Congenital postural torticollis

A

Muscular
Caused by positioning of head and neck very soon after birth
First sign: mild preference for rotation or mild tilt
Becomes reinforced by positioning, commonly undiagnosed

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15
Q

Congenital muscular torticollis (CMT)

A

Unilateral fibrosis of SCM In utero or during birth process

Etio varies - position in utero, ischemic injury to SCM in utero/during birth

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16
Q

3rd most common congenital musculoskeletal anomaly in infancy

A

CMT

Males > females

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17
Q

Approx 2/3 of babies w/ CMT have

A

Palpable tumor in SCM,
Appears during 0-3 mo
Gradually resolve by 4-6 mo

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18
Q

Common dx accompanying CMT

A

Congenital hip dysphasia (esp males)
Club foot
Metatarsus adductors
BPI

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19
Q

CMT is seen more commonly in

A

Multiple births, esp in lower baby in utero

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20
Q

Failure to treat CMT

A 
Persistent neck tilt and contracture
Plagiocephaly 
Delayed/ asymmetrical motor skills 
Cervical/thoracic scoliosis
Craniofascial deformities
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21
Q

Most common cranial deformity seen with CMT

A

Plagiocephaly

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22
Q

Sig craniofacial deformities from failure to tx CMT

A

Asymmetry of orbital fissures
Mandibular asymmetry
Feeding problems

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23
Q

Torticollis objective

A

Measure tilt of lateral flex
Active neck rotation al positions
PROM: bilateral lateral flex, flex, ext
Palp all cervical muscles and fascia, plus shoulder muscles, trunk, pelvis (secondary tightness)

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24
Q

Frequently seen postural reactions in torticollis

A 
Diff living head in prone
On involved side
-decreased/absent head and trunk righting
-decreased/absent protective 
-poor equilibrium
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25
Torticollis developmental skills
Prone may be delayed | Rolling may be delayed or asymmetrical
26
Quick rule of thumb to measure lateral neck flexion
40 deg - chin to nipple 70 deg - chin to b/n nipple and shoulder 90- chin over shoulder 100 - chin past shoulder
27
“Normal” PROM for 2-10mo rotation
100-120
28
“Normal” PROM for 2-10mo lateral flexion
65-90
29
Typical AROM 2-10 mo lateral flexion
Most 2 mo able to maintain head in line w/ body | By 10 mo, head held high or very high above horizontal
30
4 goals of PT intervention for torticollis
1. **parents to be indep w/ home program 2. Full cervical AROM and PROM 3. Age-appropriate postural control, motor milestones 4. Midline control of head, neck and body, symmetrical movement patterns
31
3 components of pt intervention for torticollis
1.Stretching 2. Positioning, 3. strengthening, handling Postural control, motor milestones
32
Key points for stretching torticollis
Low intensity, sustained, pain free (avoid micro trauma to muscle) Performed frequently throughout the day for more rapid resolution Hand placement important
33
Torticollis: PROM HEP
Lateral flexion and rotation for affected SCM Progress to teach other as they become proficient Stretch every diaper change Perform each stretch 3 times for 10-30 s or longer
34
Torticollis AROM: if neck flexors or extensor are tight
Can use Passive, active stretch Massage MFR
35
Contras to stretching for torticollis
DS Spina bifida Vertebral or spinal core abnormalities Compromised circulatory or respiratory system
36
Positioning, strengthen, handling torticollis: start w/
Tummy time -assist w/ earlier dev of motor milestones Improves arm, shoulder girdle, neck, ab strength
37
Good for gentle stretch/ prom of trunk hips and neck
Football hold
38
____ is almost always diminished in infants w/ torticollis
Postural control
39
Begin working on upright postural control at
4 mo
40
Torticollis and righting reaction
Contralateral SCM elongated and weak | Affected shorter but also weak
41
Symmetry while working on gross motor skills in both directions
``` Supine: hands to mind line Prone: on forearms or hands Rolling to both sides Quad Sitting and reaching/WB on both hands ```
42
PT intervention for torticollis w/ limited research
Myofascial release Craniofacial therapy, feldenkrais, Soft tissue massage Incorporate visual tracking and sensory awareness/stim toward side of involved SCM
43
Follow up for torticollis
3-12 mo after d/c and when walking
44
Primary factor affecting torticollis outcome
Age at initiation of tx Severity of CMT Presence of SCM mass Compliance w/ HEP
45
Conservative tx for torticollis very effective if
Initiated prior to 1yr age
46
Torticollis progression-regression pattern occur w/
Growth spurt Teething Illness Fevers
47
Sx required for complete resolution of torticollis in
8-10% cases | 3-6 mo of thorough conservative therapy w/ residual head tilt and tight muscle arm band and fascia asymmetry
48
Fascia asymmetries become irreversible if not corrected by
12 yrs old
49
Positional plagiocephaly
An abnormal or flattened headshape resulting form external molding forces to cranium
50
Plagiocephaly: MD MUST rule out
Craiosynostosis: rare condition where 1 or more cranial sutures fuse prematurely
51
Deformation of head occurs
In utero or up to approx 4 yrs old
52
Risk factors for plagiocephaly
``` CMT/positional preference Intro-uterine constraint Multiples First born child Gender Supine sleeping (or excessive use of seating devices) ```
53
Possible adverse effects of non resolved plagiocephaly
Perm cranial/facial asymmetry Elevated risk of auditory and visual processing disorder Negative social and self esteem issues Possibly neuro delays
54
Tx options for positional plagiocephaly
**Reposition Cranial banding/helmets Sx
55
When to implement repositioning for plagiocephaly
Parents must be VERY active in HEP Best for young infants (<4m) w/ mild flattening Difficult to perform on infants w/ tort.
56
Repositioning tx for plagiocephaly
``` Increase tummy time, decrease supine Alt head position during sleep Alt side of feeding Place toys/objects to non preferred side Avoid excess use of seats ```
57
Cranial banding/helmeting
Moderate to sever cases non responsive to reposition, 4mo and older
58
Early banding
Proven to work faster and more effectively than repositioning alone
59
Does plagiocephaly improve on its own?
No
60
Severe plagiocephaly deformity
Corrected more “quickly and effectively” w/ cranial orthosis than repositioning and PT
61
Most important for choosing cranial banding product
FDA approval Company is experienced w/ children Company can demonstrate safety and success of product
62
DOC band use
Young infants (<6m ideal) Very light weight and custom fit FDA for 3-18 m old
63
DOC band protocol
23 hrs/day Clinic visits to remove foam lining Anthropometric before and after Tx time in 1 band 2-4 mo
64
Sx tx for plagiocephaly
Only when child is older than 2y and has severe to extreme deformity Generally standoff of car only for tx of craniosynostosis
65
Scaphocephaly
Midline shortens | Longer A-P
66
Typical plagiocephaly
Diagonal, pushed over to one side
67
Brachyocephaly
Gets wider
68
Plagiocephaly named for
Side that’s flattened | Describe width/dimensions

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