Pediatric Congenital Torticollis

Question 1

Presentation:

Answer 1

• Infant postures head in lateral flexion towards one side (involved side) and rotation towards the opposite side
• Torticollis named for side of head tilt
• Noticeable in first few weeks after birth

Question 2

Etiology:

Answer 2

• Oligohydramnios
• Trauma during delivery
• Intrauterine malpositioning
• Breech presentation
• Ocular abnormalities
• Osseous abnormalities
• Neurological abnormalities

Question 3

Types:

Answer 3

• Congenital muscular torticollis (CMT) results from unilateral shortening of the sternocleidomastoid (SCM) on the same side as the lateral flexion & normal x-rays
• May have palpable mass or fibrosis in SCM possibly due to compromised circulation to SCM
• Congenital Postural Torticollis (CPT) – no SCM tightness, no mass, normal x-rays
• SCM Nodule Torticollis – nodule or fibrous bands in SCM

Question 4

Associated Disorders:

Answer 4

• Can cause facial asymmetry and/or unilateral flattening of the occiput (plagiocephaly)
  *

Question 5

Other Associated Disorders:

Answer 5

• Hip dysplasia
• Talipes equinovarus
• Scoliosis
• Brachial plexus injury
• Craniofacial asymmetry-recession of frontal bone, eyebrow and zygoma on ipsilateral side, posterior and inferior ipsilateral ear
• Eye and mouth displacement- ipsilateral eye smaller, canting of mandible

Question 6

Prevalence of Plagiocephaly or Cranial Deformation (CD):

Answer 6

• Increased incidence since inception of “Back to Sleep” campaign to reduce SIDS in 1992 – reduced incidence of SIDS by 50%
  
  • This accentuates issues from intrauterine constraint
• “Tummy time” emphasized more now but not widespread knowledge by general public and tolerated less by infants

Question 7

Red Flags:

Answer 7

• Acute onset after a long period of symmetry
• Right cervical flexion with right lateral flexion
• C1-C2 instability
• Children with Down syndrome
• Cardiopulmonary
  
  • If signs of respiratory distress–consult
• Trunk arching and neck flexion to right after eating
  
  • GI condition—consult
• Reflux treated with Reglan
  
  • Torticollis can be side effect

Question 8

CMT and Body Structure/Function:

Answer 8

• SCM, cervical, upper trap tightness
• SCM, cervical, upper trap weakness
• Asymmetric postures in all positions
• Possible hip dysplasia
• Red and irritated skin folds
• Pain during stretching
• Cervical and thoracic scoliosis

Question 9

CMT and Activity Limitations:

Answer 9

• Restricted cervical motion
• Positional preference and â tolerance to prone
• Asymmetrical propping on upper extremities
• Asymmetrical movements and transitions in and between developmental positions
• Resistance to stretching that increases with head control
• Asymmetrical postures in sitting and standing

Question 10

CMT and Participation Restrictions:

Answer 10

• Prefers bottle feeding on one side or only breast feeds on one side
• Reduced tolerance to prone play
• Possible delays in development
• Difficulty cleaning infant’s neck

Question 11

CD and Body Structures/Function:

Answer 11

• Lateral or bilateral occipital flattening
• Widening of posterior skull or cranial base
• Frontal bossing and/or temporal bulging
• Abnormal vertical growth of posterior skull
• Facial and ear asymmetry
• Mandible asymmetry

Question 12

CD and Activity Limitation:

Answer 12

• Visual tracing in supine
• Difficulty fitting eyeglasses

Question 13

CD and Participation Restrictions:

Answer 13

• Teasing by peers
• Difficulty bottle or breastfeeding equally on both sides