Torticollis and Plagiocephaly Flashcards
Define congenital muscular torticollis (CMT)
Unilateral shortening of the sternocleidomastoid (SCM) muscle
Describe the presentation of an infant with CMT
Lateral flexion on the ipsilateral side of the shortened SCM and rotation of the head away from the side
Pseudo-facial drooping also tends to occur in infants with CMT, what side does this occur to?
contralateral side
While shortening of the SCM may be the primary muscle involved, secondary shortening occurs in what other muscles?
- scalenes
- levator scapulae
- upper trap
When is CMT usually noted in affected children?
2 to 3 weeks after birth
Describe the proposed etiology of CMT
Specific cause is unknown, however it is associated with the formation of a mass or fibrotic tumor within the SCM
Describe 2 possible hypotheses behind the formation of the fibrotic mass
- Intrauterine malposition (breeched)
- Complicated delivery
Intrauterine malpositioning results in what that can result in anoxic injury to the SCM muscle?
occlusion of blood vessels
In regards to birth order what child is the most susceptible to torticollis?
first born
Babies born heavier than _lbs _oz have been associated with increased risk for torticollis
9 lbs 9 ounces
What are the 3 classifications of CMT?
- SCM tumor
- Muscular torticollis (MT)
- Positional torticollis (POST)
When is CMT classified as an SCM tumor?
When there is a palpable mass within the SCM
When is CMT classified as an muscular torticollis?
When contracture of the SCM muscle is present but no palpable mass is present
When is CMT classified as an positional torticollis?
When both contracture of the SCM muscle and a palpable mass are absent
Define plagiocephaly
flattening of the infants skull on one side
Other than what has already been mentioned what is a possible cause of torticollis?
Babies are placed in supine to sleep due to increased SIDS risk and begun to develop plagiocephaly which leads to torticollis
Conservative treatment of CMT is generally recommended for infants __ months and younger
12
What does the conservative management of congenital muscular torticollis include?
- Prolonged passive stretching of the SCM muscle
- Active cervical ROM with subsequent strengthening exercises
- Symmetric developmental activities to correct head position, neck, and UE positioning
How can passive SCM stretching be achieved?
through positioning and handling techniques
How should active cervical ROM be accomplished in children less than 4 months?
visual tracking of objects
How should active cervical ROM be accomplished in children older than 4 months?
equilibrium and righting reactions and developmental play
What orthotic device may be beneficial to help maintain ROM?
TOT Collar
When is a TOT collar recommended?
For infants at least 4 months old with consistent head tilt of 5 degrees or more for more than 80% of the day who perform all movements with a head tilt
Before surgical intervention should be considered what is another conservative treatment idea?
Botox injection in combination with PT
