Torticollis, Plagiocephaly, and BPI

Question 1

What does Congenital Muscular Torticollis (CMT) look like?

Answer 1

Unilateral shortening of SCM

Infants head is laterally flexed toward the shortened muscle, with the chin rotated toward the opposite side

Question 2

What are the causes of CMT?

Answer 2

• Fibrotic tumor
• Occlusion of BV with resultant anoxic injury to SCM muscle
• Intrauterine malposition or trauma at birth

Question 3

_____ born children are more susceptible because ________

Answer 3

First; the uterus is not stretched to its maximal capacity

Question 4

If the baby is over _____ lbs, the risk of injury increases by what %?

Answer 4

9.9 lbs; 60%

Question 5

Prenatal Deformations

Answer 5

Normal responses to tissue to abnormal mechanical force
extrinsic (intrauterine constraint)
intrinsic (fetal hypomobility secondary to NS impairment such as myelomeningocele)

Question 6

What is myelomeningocele?

Answer 6

Birth defect in which the spinal canal and backbone do not close before birth

Question 7

______ of the SCM is present in all children with CMT and ranges on a continuum of no palpable mass to a firm palpable mass

Answer 7

fibrosis

Question 8

CMT Types

Answer 8

1. SCM Tumor
2. Muscular Torticollis
3. Positional Torticollis

Question 9

SCM Tumor

Answer 9

definitive mass or tumor is palpable within the SCM muscle

Question 10

Muscular Torticollis (MT)

Answer 10

Contracture of the SCM is present but no palpable mass is present

Question 11

Positional Torticollis (POST)

Answer 11

Contracture of the SCM and a palpable mass are absent

Question 12

A TOT collar is recommended for an infant that demonstrates what?

Answer 12

At least 4 months

Consistant head tilt of 5 degrees or more for more than 80% of the day who perform all movements with head tilt

Question 13

Surgical Treatment for torticollis is indicated when…

Answer 13

• infants with CMT that do not respond after months of conservative treatment
• present with a residual head tilt
• deficits of passive rotation and lateral flexion of the neck more than 15 degrees

Question 14

True or False? Plagiocephaly always occurs with torticollis…

Answer 14

False - can occur without torticollis but can precipitate torticollis

Question 15

What does DOC stand for?

Answer 15

Dynamic Orthotic Cranioplasty band

Question 16

What is a DOC used for?

Answer 16

cranial band that applied pressure to the anterior and posterior prominence’s of the cranium but allows growth in the flattened areas

Question 17

What age is a DOC typically recommended for?

Answer 17

between 3 & 4 months – below 12 months of age

Question 18

What is a neurotmesis?

Answer 18

Complete rupture of spinal nerves

Question 19

What is a Axonomesis?

Answer 19

Disruption of the axons but the neural sheath is in tact

Question 20

What is Neurpraxia?

Answer 20

temporary loss of motor and sensory function

Question 21

How much do axons grow in 1 day?

Answer 21

1 mm

Question 22

When does Brachial Plexus birth palsy occur?

Answer 22

Injury that occurs during the process of childbirth

Question 23

What are the risk factors of Brachial Plexus Brith Palsy?

Answer 23

1. Shoulder Dystocia (shoulder gets stuck behind pubic bone after head)
2. Maternal Diabetes (Large gestational age)
3. Difficult Deliveries

Question 24

Traction and rotation of the head tends to injure which nerve roots?

Answer 24

C5 and C6

Question 25

What nerve roots, when injured, constitute Erb’s Palsy?

Answer 25

C5 and C6

Question 26

If C4 is damaged - what can occur?

Answer 26

ipsilateral hemiparesis of the diaphragm

Question 27

The most common injury is to the _____ roots of ______. (______)

Answer 27

upper roots; C5 & C6 (Erb’s Palsy)

Question 28

Changes that occur usually resulting from Erb’s Palsy

Answer 28

Shoulder held in: Extension, IR, and adduction
Elbow extended
Forearm pronated
Wrist and fingers flexed
Grasp is in tact but sensory loss may be present

Question 29

If C7 is involved in BPI, elbow and finger _______ is compromised

Answer 29

extension

Question 30

What is Erb-Klumpke Palsy

Answer 30

Combinaton of the injury to the upper and lower roots of C5-T1

Question 31

What is the result of Erb-Klumpke Palsy?

Answer 31

Total arm paralysis and loss of sensation
Involvement typically unilateral and pattern of motor loss does not always fit classic definitions indicating incomplete or mixed upper/lower types

Question 32

What is Horner’s Syndrome?

Answer 32

deficient sweating, recession of eyeball, abnormal pupillary contraction…

Question 33

What is Klumpke’s Palsy?

Answer 33

Involves only the lower roots of C7-T1

Question 34

What does Klumpke’s Palsy look like?

Answer 34

Shoulder and elbow movements are not impaired but the resting position of the forearm is in supination
paralysis of wrist flexors/extensors and intrinsic hand muscles

Question 35

What is one of the biggest complications of Klumpke’s Palsy?

Answer 35

Scoliosis

Question 36

List the Observation/Examination Findings in Erb-Klumpke Palsy

Answer 36

UE Neglect
Soft Tissue Contractures
Abnormal Bone Growth

Question 37

List the Orthopaedic Abnormalities associated with Erb-Klumpke Palsy

Answer 37

Flattening of humeral head
Shortened Clavicle
Hypoplasia of humeral head
Abnormal glenoid fossa