Torticollis and Plagiocephaly

Question 1

What is torticollis

Answer 1

• congential musclar torticollis (CMT)
• third most common Musculoskeletal abnormality in infants next to hip dysplagia and club foot

Question 2

1. What can torticollis also be know by?
2. what ages can it occur?
3. can it be aquired?

Answer 2

1. wry neck
2. can occur at all ages
3. can be acquires or congential

Question 3

What is the etiology of torticollis/who may be more at risk

Answer 3

• primary postulated SCM
• fetal malpositioning
• interauterine crowding (multiple births)
• prematurity
• first born
• Males: higher incidence
• breech

Question 4

Torticollis position

Answer 4

• the head is typically tilted in lateral flexion towards the affected SCM in the frontal plane and rotated toward the opposite side in the transverse plane

Question 5

What are the reported causes of CMT

Answer 5

• traumatic delivery
• primary myopathy
• fibrosis due to peripartium bleeding
• intauterine postural abnormality
• intrauterine or perinatal compartment syndrome theory and the hereditary hypothesis

Question 6

Torticollis palpable mass

Answer 6

• torticollis results from injury during labor and delivery or utero
• the palpable mass usually grows for up to 1-2 months after birth and then gadually decreases in size and disappears by the second year

Question 7

What are the differnet types of torticollis diagnosis

Answer 7

• skeletal boney malformation: of the skull and cervical spine
• neurologic: tumor posterior fossa, ocular tumor, arnold chiari, sandifer
• muscular: most common congential muscular deformity and tight unilateral SCM

Question 8

What does an infant demonstrate with torticollus

Answer 8

• head tilt to effected side
• exteneral ear close to shoulder
• face rotated unaffected side
• depicted anytime birth to 12 months
• visual tracking
• imbalance of ears (missshaped head)
• neglect of arm on affected side

Question 9

Assoicated issues with CMT

Answer 9

• accompanied by cranial deformation
• hip dysplasia
• BPI
• distal extremity deformities
• head tilt and neck rotation to the same side (less frequently)
• correlates with acid reflex

Question 10

measurment of CMT (torticollis)

Answer 10

• not a lot of consistency

Question 11

What is US and CMT used for

Answer 11

• evaluation of fibrotic lesions within the SCM
• measures muscle mass or thickness and is therefore widely used in MSK medicine

• US elastography has been used as a noninvasive method for evaluating and detecting tumors in various tissues including liver, brreast, kidney, thyrroid and spleen, and has been developed to allow the objective assessment of muscle stiffness

Question 12

Torticollis with physical therapy

Answer 12

• role of early PT investigated including stretching of C/S was effective at elongating/increased elasticity of SCM in CMT infants
• little demonstration by measuring correlation between SWV value and reduction of stiffness in SCM

(Shear Wave Velocity) is a measurement used in Shear Wave Elastography (SWE) to assess the stiffness of SCM

Question 13

How can US be used with diagnosis of CMT

Answer 13

• assessment of SWV by ARFI may provide an alternative method for evaluation of SCM stiffnesss

Shear wave velocity
acoustic Radiation Force Impulse: US technique

Question 14

What is the treatment for CMT

Answer 14

• handling strategies
• specific strength exercises
• the head righting reaction is used to stimulate muscle function in both handling and exercises

Question 15

How often should infants by in tummy time

Answer 15

• 30 minutes per day
• the more the better
• begin with 1 minute gradually increase to 10 minutes at a time or more depending on babies tolerance
• Do with every diper change

Question 16

What is plagiocephaly

Answer 16

• skull asymmetrical
• flattened posterior skull
• often seen with torticollis due to infant having a preferred head rotation with uneven skull weight bearing

Question 17

What are some features of Plagiocephaly

Answer 17

• parallelogram shape
• flattening of parietal/occipital area, advancement of the ipsilateral ear/eye
• contralateral flattening of the frontal/temporal region
• may have head height on one side

Question 18

What is brachycephaly

Answer 18

• flattening on the posterior skull
• usually infant in supine position primarily
• head is wider than it is tall
• increased parietal width and decreased length
• normal head should be 1/3 longer than wide

Question 19

What is scaphocephaly

Answer 19

• head is taller than wide
• seen with more mature infants having respirtory support from C-pap

Question 20

CMT: classifications

Answer 20

• CMT is a mucular disorder causing torticollis at brith or shortly after
• classified SCM patients as having either fibromatosis colli with palpable mass or
• idiopathic muscular torticollis with shortening of SCM without a mass