Torticollis and Plagiocephaly Flashcards
1
Q
CMT
A
congenital muscular torticollis
2
Q
what does torticollis lead to (positioning)
A
ipsilateral SB and contralateral rotation
3
Q
what side is torticollis named by
A
side of muscle shortening
4
Q
what does torticollis commonly occur with
A
- hip dysplasia
- brachial plexus injury
- metatarsus adductus
- plagiocephaly
- facial asymmetries
- may see shortening of scalenes, levator scapulae, upper trap
5
Q
prenatal and perinatal theories for torticollis
A
prenatal
- ischemic injury, intrauterine compartment syndrome, intrauterine crowding, hereditary factors
perinatal
- neurogenic injury, birth trauma (direct injury to the muscle or rupture of muscle during birthing process)
6
Q
risk factors for torticollis
A
- large birth weight
- multiple birth
- male gender
- breech position
- difficult labor or delivery
- use of vacuum or forceps for delivery
- maternal uterine abnormalities
7
Q
3 types of ways to differentially diagnosis torticollis when it is a non-muscular etiology
A
- osseous (klippel-feil syndrome and hemivertebrae)
- non-ossseous (grisels syndrome, sandifer syndrome)
- neurologic (brachial plexus injury, ocular dysfunction, arnold-chiari malformation)
8
Q
klippel feil syndrome
A
fusion of 2 cervical vertebrae
9
Q
hemivertebrae syndrome
A
one cervical vertebrae develops on one side and not the other
10
Q
grisel’s syndrome
A
atlanto-axial subluxation caused by upper respiratory issue
11
Q
sandifer syndrome
A
caused by GERD
12
Q
what are the 3 types of CMT
A
- postural/positional torticollis
- muscular torticollis
- sternomastoid tumor
13
Q
postural/positional preference
A
- infants born with postural preference
- no tightness of SCM and no PROM restrictions
- no mass, x-rays normal
14
Q
muscular torticollis
A
- tightness of SCM with ROM limitations
- no mass, x-rays normal
15
Q
sternomastoid tumor
A
- discrete mass or fibrotic thickening of SCM
- PROM limitations
- x-rays normal
16
Q
found within SCM belly and appears within first 2 weeks of life and gradually disappears
A
associated fibrotic tumor
17
Q
dx of torticollis
A
- often within first 2-3 weeks after birth, milder cases up until 6 months of age
- parents or pediatricians note a head tilt or rotational preference
- clinical presentation
- palpation of SCM
- x-rays (not always)
18
Q
important aspects of birth/health history for torticollis
A
- chronological/corrected age
- age of onset
- pregnancy hx
- delivery hx
- birth presentation
- head posture/preference and head/face asymmetries
- family hx
- other medical conditions
- developmental milestones
19
Q
assessing posture in torticollis
A
- general posture in all developmental positions
- measure degree of resting head tilt via still photography in supine
20
Q
how to measure resting head tilt
A
- draw line through acromion and through midpoints of both eyes
- intersection angle to measure head tilt
21
Q
ways to measure cervical rot and SB
A
- % of unaffected side
- tape measure
- arthrodial protractor
- anatomical landmarks
22
Q
normal lateral flexion
A
70 deg
23
Q
normal rotation
A
110 deg
24
Q
nipple line rotation
A
40deg
25
between nipple line and shoulder
70deg
26
shoulder
90 deg
27
past shoulder
100deg
28
how to perform AROM in infants <3 m/o
performed in supine
29
how to perform AROM in infants > 3 m/o
performed in sitting
30
how to measure muscular strength in infants less than 2 m/o
muscle function scale (MFS)
31
score of 5 on MFS
- head held high above horizontal line, almost vertical
- > 75deg
32
score of 4 on MFS
- head held high over horizontal line > 45deg
- >45 <75
33
score of 3 on MFS
- head held high over horizontal, but < 45 deg
- >15 deg < 45deg
34
score of 2 on MFS
- head held slightly over horizontal line
- > 0 < 15 deg
35
score of 1 on MFS
- head held in horizontal
- 0 deg
36
score of 0 on MFS
- head below horizontal
- < 0deg
37
how to perform MFS and how is it scored
- hold infant vertically in front of mirror and then tip them horizontally
- observe righting position
- must be held for 5 seconds
38
head tilt to maintain binoocularity or to optimize visual acuity
ocular torticollis
39
how to test for ocular torticollis
sit up test
40
easy outcome to measure developmental/gross motor exam for torticollis
AIMS
41
infants with CMT, prone positioning at least _____ x/day is correlated with higher AIMS scores
3
42
interventions started ____ will have 98% of pts with normal ROM within 1.5 months
before 1 month
43
interventions beginning _____ may need interventions for > 6 months
after 1 m/o
44
waiting until ____ may require 9-10 months of tx and may not achieve full ROM without surgical intervention
after 6 months
45
5 first choice interventions for torticollis
- PROM
- neck and trunk AROM
- developmental exercises to promote symmetry of movements
- environmental adaptations
- parent education
46
supplemental interventions for torticollis
- STM
- kinesiotape
- TOT collar
47
if conservative tx fails after how many months should you refer and at what age should surgery be performed by to allow for better outcomes
- 6 months of conservative tx
- before age 8
48
criteria for discharge from PT for torticollis
- PROM within 5 deg of non-effected side
- symmetrical active movement patterns
- age appropriate motor development
- no visible head tilt
- parents/caregivers understand what to monitor as child grows
49
asymmetrical flattening of skull
plagiocephaly
50
causes of skull deformation
- neonatal: first born, prolonged labor or tool assisted delivery, prematurity or low birth weight, torticollis
- environmental factors: prolonged placement in one position, lack of prone position, increased time in positioning device
51
premature fusion of cranial sutures
craniosynostosis
52
positional plagiocephaly features
- ipsilateral frontal bossing
- ipsilateral ear displaced anteriorly
- contralateral occipital bossing
- parallelogram shape
53
craniosynpstosis features
- contralateral frontal bossing
- ipsilateral ear displaces posteriorly
- ipsilateral occipitoparietal flattening
- contralateral parietal bossing
- trapezoid shape
54
which is conservatively managed is which has to be managed surgically (plagiocephaly vs craniosynostosis)
- conservative = plagiocephaly
- surgically = craniosynostosis
55
back of head becomes flattened symmetrically
brachycephaly/dolichocephaly
56
sagittal synostosis - skull becomes enlarged
scaphocephaly
57
1st choice interventions for plagiocephaly for infants 0-4 m/o without torticollis
- parent education, repositioning exercises
- goal: shift infant off flattened areas to encourage symmetrical head shape
- referral to PT if resistant to repositioning, neck tightness, head shape worsens or does not improve
58
- goal: encourage symmetrical skull growth
cranial remodeling orthosis (CRO)
59
what age group is CRO for
3-18 months with moderate to severe skull deformity
60
optimal age for initiating CRO tx
4-6 months
61
how often is CRO worn
23 hours/day
62
how often is follow up for CRO
2-3 weeks
63
goal: parent education, resolve ROM deficits, strengthen weak muscle groups, promote age appropriate motor development
PT
64
- measures plagiocephaly
- measurement is taken diagonally
- 3 measurements and take the average
cranial vault asymmetry index (CVAI)
65
- measures brachycephaly
- 3 measurements
- measure medial/lateral and anterior/posterior
cephalic index (ratio) (CI)
