Torticollis and Plagiocephally

Question 1

What is torticollis?

Answer 1

“Wry neck,” commonly a lateral flexion with a rotation to the opposite side (named in the direction of the lateral bend).

Question 2

What are the 3 subgroups to Torticollis?

Answer 2

1. Sternocleido mastoid tumor torticollis (SMT) - 43% of cases - there is a palpable fibrous tumor
2. Muscular torticollis (MT) - 31% of cases - no palpable tumor, but there is a limited cervical ROM
3. Positional torticollis (POST) - 22% of cases - no tumor or range restrictions - mostly alignment

Question 3

What are some prenatal risk factors to torticollis?

Answer 3

• 1st pregnancy
• Male (usually bigger)
• multiple gestations (out of room)

Question 4

What are some perinatal or post-natal risk factors to torticollis?

Answer 4

• Prematurity
• Assisted delivery
• Positioning preference
• Cumulative exposure to supine position (need that tummy time)
• Orthopedic or neurological dysfunction

Question 5

What is the overall incidence rate of torticollis?

Answer 5

6-10% of cases

Question 6

SIDS can be prevented by 40% if ……

Answer 6

• child sleeps on its back

Question 7

The most important treatment to torticollis and plagiocephaly is what?

Answer 7

• Prevention awareness

Question 8

What is plagiocephally?

Answer 8

“oblique head” defined by asymmetry of the cranial bones

Question 9

What are the 2 subgroups to plagiocephally?

Answer 9

• Deformational (or positional) plagiocephally?

- Craniosynostosis

Question 10

What are the risk factors for Deformational Plagiocephaly?

Answer 10

• Positional preference (60% chance if they are a preference)
• Container syndrome (carrying kid in device everywhere) and not holding child enough
• Deformational forces (leaving child on a flat and hard surface can cause bossing and flattening - can lead to Ottis Media (infection of air space behind eardrum))

Question 11

How do you treat Deformational Plagiocephaly?

Answer 11

• Cranial remodeling and Repositioning and PT programs
• Studies show that a 4 month program to children with positional preference significantly reduces positional plagiocephaly)

Question 12

What are the types of craniosynostosis?

Answer 12

• Coronal suture synostosis
• Metopic suture synostosis (in normal developing individual, frontal bones divided, so this fuses early)
• Sagital synostosis

Question 13

What is a normal variation for cranial vault asymmetry?

Answer 13

normal variation is 3mm or 4 mm. anything greater is considered abnormal. (refer to chart in torticollis/ plagiocephally PP; levels 1-5)

Question 14

Describe a normal 12 month old’s cervical ROM

Answer 14

• usually 110 degrees rotation and 70 degrees lateral flexion
  ~ 40 degrees chin to nipple on involved side
  ~ 70 degrees chin between nipple and shoulder on involved side
  ~ 90 degrees chin over shoulder on involved side
  ~ 100 degrees chin past shoulder on involved side

Question 15

What is Ohman’s Muscle Function Scale for Infants?

Answer 15

4) Head held very high over horizontal
3) Head high over horizontal
2) Head slightly over horizontal
1) Head at horizontal
0) Head below horizontal

Question 16

What should you inform parents regarding torticollis and plagiocephally?

Answer 16

• Variety of positions other than supine
• Tummy time
• Alternate infant’s head position
• Use car seats ONLY for transportation
• Limit use of baby equipment
• Head shape remodeling should resolve by 2 months of age … if not, parent should consult a peditratician