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Peds > Torticollis > Flashcards

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
Q

Torticollis developmental skills

A

Prone may be delayed

Rolling may be delayed or asymmetrical

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26
Q

Quick rule of thumb to measure lateral neck flexion

A

40 deg - chin to nipple
70 deg - chin to b/n nipple and shoulder
90- chin over shoulder
100 - chin past shoulder

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27
Q

“Normal” PROM for 2-10mo rotation

A

100-120

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28
Q

“Normal” PROM for 2-10mo lateral flexion

A

65-90

29
Q

Typical AROM 2-10 mo lateral flexion

A

Most 2 mo able to maintain head in line w/ body

By 10 mo, head held high or very high above horizontal

30
Q

4 goals of PT intervention for torticollis

A
  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
Q

3 components of pt intervention for torticollis

A

1.Stretching
2. Positioning,
3. strengthening, handling
Postural control, motor milestones

32
Q

Key points for stretching torticollis

A

Low intensity, sustained, pain free (avoid micro trauma to muscle)
Performed frequently throughout the day for more rapid resolution
Hand placement important

33
Q

Torticollis: PROM HEP

A

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
Q

Torticollis AROM: if neck flexors or extensor are tight

A

Can use
Passive, active stretch
Massage
MFR

35
Q

Contras to stretching for torticollis

A

DS
Spina bifida
Vertebral or spinal core abnormalities
Compromised circulatory or respiratory system

36
Q

Positioning, strengthen, handling torticollis: start w/

A

Tummy time
-assist w/ earlier dev of motor milestones
Improves arm, shoulder girdle, neck, ab strength

37
Q

Good for gentle stretch/ prom of trunk hips and neck

A

Football hold

38
Q

____ is almost always diminished in infants w/ torticollis

A

Postural control

39
Q

Begin working on upright postural control at

A

4 mo

40
Q

Torticollis and righting reaction

A

Contralateral SCM elongated and weak

Affected shorter but also weak

41
Q

Symmetry while working on gross motor skills in both directions

A 
Supine: hands to mind line
Prone: on forearms or hands
Rolling to both sides
Quad
Sitting and reaching/WB on both hands
42
Q

PT intervention for torticollis w/ limited research

A

Myofascial release
Craniofacial therapy, feldenkrais, Soft tissue massage
Incorporate visual tracking and sensory awareness/stim toward side of involved SCM

43
Q

Follow up for torticollis

A

3-12 mo after d/c and when walking

44
Q

Primary factor affecting torticollis outcome

A

Age at initiation of tx
Severity of CMT
Presence of SCM mass
Compliance w/ HEP

45
Q

Conservative tx for torticollis very effective if

A

Initiated prior to 1yr age

46
Q

Torticollis progression-regression pattern occur w/

A

Growth spurt
Teething
Illness
Fevers

47
Q

Sx required for complete resolution of torticollis in

A

8-10% cases

3-6 mo of thorough conservative therapy w/ residual head tilt and tight muscle arm band and fascia asymmetry

48
Q

Fascia asymmetries become irreversible if not corrected by

A

12 yrs old

49
Q

Positional plagiocephaly

A

An abnormal or flattened headshape resulting form external molding forces to cranium

50
Q

Plagiocephaly: MD MUST rule out

A

Craiosynostosis: rare condition where 1 or more cranial sutures fuse prematurely

51
Q

Deformation of head occurs

A

In utero or up to approx 4 yrs old

52
Q

Risk factors for plagiocephaly

A 
CMT/positional preference
Intro-uterine constraint
Multiples
First born child
Gender
Supine sleeping (or excessive use of seating devices)
53
Q

Possible adverse effects of non resolved plagiocephaly

A

Perm cranial/facial asymmetry
Elevated risk of auditory and visual processing disorder
Negative social and self esteem issues
Possibly neuro delays

54
Q

Tx options for positional plagiocephaly

A

**Reposition
Cranial banding/helmets
Sx

55
Q

When to implement repositioning for plagiocephaly

A

Parents must be VERY active in HEP
Best for young infants (<4m) w/ mild flattening
Difficult to perform on infants w/ tort.

56
Q

Repositioning tx for plagiocephaly

A 
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
Q

Cranial banding/helmeting

A

Moderate to sever cases non responsive to reposition, 4mo and older

58
Q

Early banding

A

Proven to work faster and more effectively than repositioning alone

59
Q

Does plagiocephaly improve on its own?

A

No

60
Q

Severe plagiocephaly deformity

A

Corrected more “quickly and effectively” w/ cranial orthosis than repositioning and PT

61
Q

Most important for choosing cranial banding product

A

FDA approval
Company is experienced w/ children
Company can demonstrate safety and success of product

62
Q

DOC band use

A

Young infants (<6m ideal)
Very light weight and custom fit
FDA for 3-18 m old

63
Q

DOC band protocol

A

23 hrs/day
Clinic visits to remove foam lining
Anthropometric before and after
Tx time in 1 band 2-4 mo

64
Q

Sx tx for plagiocephaly

A

Only when child is older than 2y and has severe to extreme deformity
Generally standoff of car only for tx of craniosynostosis

65
Q

Scaphocephaly

A

Midline shortens

Longer A-P

66
Q

Typical plagiocephaly

A

Diagonal, pushed over to one side

67
Q

Brachyocephaly

A

Gets wider

68
Q

Plagiocephaly named for

A

Side that’s flattened

Describe width/dimensions

Peds (18 decks)

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