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Lizanne Peds NM > Torticollis > Flashcards

Torticollis Flashcards

1
Q

What is CMT?

A

Congenital Muscular torticollis. Postural deformity evident shortly after birth.

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2
Q

What causes CMT?

A

Unilateral shortening of the SCM characterized by IL side flexion, and opp rotation

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3
Q

What side is the CMT name by?

A

For the side of the tightness.

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4
Q

What is the prevalence of CMT?

A

3rd most common congenital MSK condition.

Male > Female

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5
Q

What do children with CMT have trouble developing?

A

Vision and midline motor activities.

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6
Q

What is CMT associated with 80-90% of the time?

A

Plagiocephaly

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7
Q

What is plagiocephaly?

A

Defined as slanting/flattening of the head. Occipital asymmetry.

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8
Q

What are some other skull characteristics you may see with plagiocephaly?

A 
IL ear positioned anterior or inferior
Frontal bossing
Facial asymmetry
Temporal bossing
Posterior vertical cranial growth
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9
Q

Causes of plagiocephaly

A 
Uterine constraint due to multiple births
Assisted delivery with forceps or vacuum
Premature birth
Prolonged Labor
Inadequate tummy time
Nonvarying nursing/bottle feeding habits
Developmental Delay
Torticollis
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10
Q

Resolution of Plagiocephaly

A

Many head deformities resolve during the first few months of life if the infants head is frequently repositioned.
Can get worse over time
If significant at 4 mo helmeting may be needed

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11
Q

Concepts for positioning for play

A

Limit time in devices where head is resting on hard devices
Alternate infant position in the crib with head at either end
Promote tummy time!

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12
Q

What does helmet therapy do?

A

Redirect growth

Improve symmetry of cranial vault cranial base and face.

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13
Q

Etiology of CMT at birth

A

Due to constraint during last few weeks of gestation

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14
Q

What is fibroma in CMT?

A

Pseudotumor of infancy. Develops at 2-3 weeks of life resolves by 4-6 mo. Painless and in middle to lower 1/3 of the sternal portion of SCM.

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15
Q

What are the two categories of torticollis?

A

Acquired and Congenital (Acquired is subdivided into traumatic and atraumatic)

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16
Q

What disorders/conditions are associates with acquired non-traumatic torticollis?

A

Occular conditions, orthopedic abnormalities, sandifer syndrome, klippel-feil syndrome, Benign paroxysmal torticollis, infections conditions, neurologic syndromes.

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17
Q

Occular torticollis

A

Infant may tilt head to correct vision d/t visual impairment.

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18
Q

Potential impairments causing occular torticollis

A 
Strabismus
Nystagmus
Inconsistent visual tracking
Gaze aversion
Typically due to unilateral superior oblique muscle weakness
19
Q

What orthopedic abnormalities can it result in?

A

Can result in scoliosis

20
Q

Sandifer syndrome

A

Onset in infancy/early childhood (18-36 mo peak)
Spasmodic neck dystonia with arching of the back and posturing of the neck back and UE.
May look like a seizure
GER or hiatal hernia
Severe hypotonia may be noted

21
Q

Klippel-Feil Syndrome

A

Genetic
congenital fusion of C2-C7
Webbed short neck, low hairline
abnormalities of head/face/sex organs, muscles extremities and heart

22
Q

Benign paroxysmal torticollis

A

Tort posture but involved side switches. Resolves around 2-3 y.o. Can be assoc with nausea vomiting ataxia, irritability and drowsiness. Migranes.

23
Q

Comorbid conditions.

A

Hip dysplasia (+ on side of torticollis)
Club foot
Metatarsus adductus
Brachial plexus injury

24
Q

Types of torticollis

A 
SCM tumor/fibrotic nodule
Muscular torticollis (tightness/thickening of muscle may have fibrotic band)
Postural torticollis (without tumor or tightness)
25
Q

Normal CROM to 12 mo

A 
Rot: 100 deg
Lateral Flex: 70 deg
Extension: 45
Cervical Flex: 45
Capital Flex: 10
26
Q

How many severities of torticollis are there?

A

Seven

27
Q

Stratification of CMT

A

Age at initiation of Tx, type, amount of PROM tightness

28
Q

What is early tort? late?

A

Early: 0-6 mo
Late: 7-12

29
Q

what are the rotation limitation severities?

A

mild: 30

30
Q

deficits on UE IL side

A

decreased reaching toward midline with forearm supination shoulder ER, and or flexion, decreased crossing midline during reaching, decreased development of protective extension reaction

31
Q

Trunk/LE asymmetry

A 
c surve or s curve in spine, 
with IL leg: decreased kicking/hands to feet
Asym LE position in sitting
Tripod position during creeping
Asym in supported standing and sitting
32
Q

Sequela of postural abnormalities

A

Neglect of IL hand, decreased awareness of IL visual field
Decrease symmetry in development of head righting, uneven WB, delayed gross motor skills, incomplete devel of automatic balance reactions

33
Q

Other muscle involvement in tort

A 
SCM
Upper trap
Scalenes
Platysma
Lev Scap
Suboccipitals
Neck extensors
Muscles of mastication, UE, Trunk
LE
34
Q

CMT evaluation: general history

A

Pregnancy: complications/bed rest/decreased amniotic fluid
Delivery: full term?, method, length/weight at birth, presence os skull or facial asymmetry at birth, birth order
Current health: prone play tolerance, preferred sleep position, feeding/GI, refulx ,feeding pos.
Devices: how long, which ones

35
Q

CMT evaluation: torticollis history

A 
When was tort first noticed?
Has it changed since initially noticed?
Sudden onset? 
Testing?
Hx of treatment to date
36
Q

CMT systems review

A

Vision screen (midline visual focus, tracking, eyes moving together)
Hearing Screen
Neuro Screen (ATNR should be int. by 4-5 mo), presence of sustained clonus, muscle tone
Pain Screen: NIPS, FLACC
Integument screen: folds, redness

37
Q

Muscle function scale for lateral righting

A

infants of 2 mo had med score of 1
inc to 3-4 by 10 mo.
Don’t use in infants

38
Q

Tests for hip dysplasia

A

Barlow/Ortilani
Galleazi: (+) leg/knee lower on side of dislocation (hooklying)
Thigh/gluteal folds: asymmetry on side of dislocation
Hip Abduction

39
Q

FIrst choice of treatment

A 
Neck PROM
Neck and Trunk AROM (strengthening)
Development of symmetrical movement
Environmental adaptations/positioning
Parent/caregiver education
40
Q

Positioning techniques

A

Nesting & Prone towel rolls with functional activities.

41
Q

Stretching protocol for torticollis

A 
Daily basis (at least 3x/day up to 6-8x/day)
Low load sustained stretches recommended 10-30 sec up to 2 min
Hand placement is important (stabilize shoulder/trunk, support infant & prevent compensations)
42
Q

Strengthening techniques

A 
tummy time
active rotation prone and sitting
active flexion (work on symmetry)
Rolling
Lateral flexion 
head righting
43
Q

When is medical management recommended

A

lack of progress after 6 mo conservative treatment or child begins PT after i eyar of age and has significant restrictions or mass. (Botox, surgical release)

44
Q

Surgery indications

A

Not responding after 6 mo
Approaching 1 yr with no resolution
Deficits of PROM rotation and lateral flexion > 15 degrees
Tight fibrotic muscular band or tumor

Lizanne Peds NM (9 decks)

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