Torticollis/Genetics/Spine Flashcards
Risk factors for torticollis. What are the most common?
- large birth weight
- male
- multiple births
- primiparous mother (1st pregnancy and 1st birth)
- use of vacuum or forceps assist
- nuchal cord
- maternal uterine abnormalities
Most common
- difficult labor and delivery
- breech position
torticollis is associate with what
- hip dysplasia
- clubfoot
- CBPI
Torticollis is an initial sign in __________ tumors.
- What are symptoms?
posterior fossa
- symptoms of headache, nausea, and vomiting
What are the 4 subtypes of torticollis?
- SCM tumor
- Muscular torticollis
- Postural torticollis
- Postnatal torticollis
SCM Tumor torticollis characteristics
- discrete mass palpable on SCM
- normal x-ray
- tissue changes - fibrosis, hyperplasia, and atropthy
Muscular torticollis characteristics
- tightness but no palpable mass
- normal x ray
- head tilt, ROM limitations, cervical muscle imbalance
Postural torticollis characteristics
- no mass, no tightness of SCM
- normal x ray
- head tilt, no PROM limitations, AROM limitations, cervical muscle imbalance
What are possible causes of congenital muscular torticollis?
- benign paroxysmal torticollis
- congenital absence of cervical muscle(s) or transverse ligament
- contracture of other neck muscles
Postnatal Muscular torticollis characteristics
- environmental induced (laying on same side)
- plagiocephaly induced (asymmetrical head)
- positional preference induced
Which subtype of torticollis will have A/PROM limitations and which subtype will only have AROM limitations?
A/PROM limitations - muscular torticollis
AROM limitations only - Postural torticollis
What is the sign for plagiocephaly?
Anterior progression of the ear on the same side as the flattened occiput
Brachycephaly
a condition where the head is disproportionately wide
- Baby who spends a lot of time on their back
Scaphocephaly or dolichophaly. What population is this common in?
a condition where the head is disproportionately long and narrow
Common in babies born prematurely
craniosynostosis. What can this result in?
early fusion of the suture of the bones of the skull
- may result in increased cranial pressure
shape of lamboid craniosynostosis head
skull takes on trapezoid shape (wider in front, narrower in back)
What are the associated changes in body structure with torticollis?
- decreased ipsilateral cervical rotation
- decreased cervical lateral flexion
favor extension
- Will lack flexion and midline control
- May favor ATNR to side they are facing and may neglect other side
- Will not like tummy time
Red Flags in Initial Presentation of Torticollis in Children (9)
- age of presentation greater than 6 months
- pain
- neurologic findings
- associated syndromes (down, skeletal dysplasia)
- trauma
- inflammatory or infectious history
- alternating sides
- atypical position
- late onset
Motor Characteristics of Children with Torticollis
- supine - trouble centering head to midline
- bias towards extension and asymmetry
- visual gaze toward side of head turning
- prone - altered forearm weight bearing
- cascade - abdominals, trunk and extremity righting
normal PROM neck rotation and lateral flexion for babies
neck rotation - 110
lateral flexion - 70
What is the muscle function scale?
- used to assess torticollis - football hold baby
1-6 scale with 1 (head held significantly below horizontal line/most severe) to 6 (head held significantly higher above horizontal line/least severe)
indications for a TOT collar
- 4 months or older
- constant tilt of 5 deg or greater for more than 80% of awake time
- perform all movement and motor skills w/ tilt
- adequate ROM and head tilting reactions
discharge guidelines for torticollis
- full PROM and AROM
- maintain midline 95% of time
- no compensatory pattern
- = and age appropriate head righting
contraindications for cranial orthoses
- craniosynostosis
- unshunted hydrocephalus
- children beyond 18 months of corrected age
- babies under 3 months of age
Monogenic, polygenic, cytogenetic
mono - single gene involved
poly - many genes involved
cyto - large-scale changes in chromosomes
