Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MSK 3 final > Congenital Muscular Torticollis > Flashcards

Congenital Muscular Torticollis Flashcards

(82 cards)

Start Studying
1
Q

definition:

A

postural deformity evident shortly after birth

typically presenting as side bending of the neck to one side and head or chin rotation to the opposite side

due to shortening of sternocleidomastoid muscle on one side of the neck

may be accompanied by other msk or neurological conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

named by:

A

side of the tight muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

torticollis R sided =

A

nose/face rotates to L

R ear tilts to R shoulder

tight R SCM muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

incidence:

A

1 in 6 newborns (16%)

more prevalent in males - 3:2

15% of babies with CMT also have hip dysplasia

CMT frequently is accompanied with cranial deformation = distortion of shape of skull due to mechanical force occurring prenatally and postnatally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

types of CMT

A

postural
muscular
SCM mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

postural CMT

A

most mild form

infant exhibits postural preference without muscle tightness or restriction to PROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

muscular CMT

A

characterized by tightness of SCM muscle and limitation of PROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

SCM mass CMT

A

most severe form

presents with thickening of SCM muscle and restricted PROm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

etiology:

A

prenatal factors
perinatal factors
postnatal factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

prenatal factors:

A

longer body length

intrauterine crowding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

perinatal factors:

A

birth trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

postnatal factors:

A

positional preference
containers
gastrointestinal reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

identification - who?

A

physicians
nurse
midwives
obstetrical nurses
nurse practitioners
lactation specialists
PTs
any clinician or family member

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

identification - what?

A

refer infants to their primary physician and a PT with expertise in infants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

identification - when?

A

earlier the better if they notice:

postural preference
reduced cervical ROM
SCM mass
craniofacial asymmetry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

prognosis:
referral before 1 month

A

98% of infants achieve near normal range within 1.5 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

prognosis:
referral between 1-6 months

A

prolongs interventions to about 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

prognosis:
referral after 6 months

A

requires 9+ months of intervention with fewer infants achieving near normal range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

possible complications if untreated:

A

1) trouble bringing their hands to midline

2) delayed visual development and visual tracking

3) problems with motor planning

4) decreased or limited protective responses on affected side

5) asymmetrical motor skills and transitional movements

6) cranial deformation

**they are always lying on that side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

shortening of the ____ shortly after birth

A

sternocleidomastoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

named by ____

A

side of tight muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

frequently accompanied with ____

A

cranial deformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

can lead to delays in ____ and ____

A

motor
visual development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

_______ and ______ is key

A

early diagnosis
treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Examination:
document infant history routines exam body structures strength and mobility
26
Family Interview - History
Age at initial visit (chronological and corrected age)  Age of onset of symptoms   Pregnancy history including maternal sense of whether the baby was “stuck” in one position during the final 6 weeks of pregnancy  Delivery history including birth presentation (cephalic or breech); use of assistance during delivery such as forceps or vacuum suction  Head posture/preference and changes in the head/face  Family history of torticollis or any other congenital or developmental conditions  Other known or suspected medical conditions  Developmental milestones appropriate for age 
27
Family Interview - Routines
feeding sleeping tummy time time in equipment/devices daycare/sitter
28
Posture and Positioning
Observe the infant in all positions, documenting alignment, preferred positioning, posturing, and tolerance supine prone supported upright positions sidelying
29
supine =
Document the side of torticollis, asymmetrical hip, trunk, and extremity positions, facial and skull asymmetries, restricted AROM
30
prone =
Document asymmetry of the spine, the head on the trunk, asymmetrical use of the extremities, and the infant’s tolerance
31
supported upright positions =
Document asymmetrical preferential postures and compensations in the shoulders, trunk, and hip
32
side lying =
Document asymmetries, trunk flexion or extension, head lifting, leg position
33
Bilateral AROM – Cervical Rotation and Lateral Flexion
Assess in supine and supported upright if age appropriate Asymmetrical and compensatory movements can indicate muscle tightness, restrictions or weakness Treatment to improve AROM consistent with goals of early intervention
34
Bilateral PROM – Cervical Rotation and Lateral Flexion
Severity of CMT determined by difference between left and right PROM measures of cervical rotation
35
Normal value passive cervical rotation for child < 12 months:
110 ± 6 degrees
36
Normal value passive lateral flexion for child < 12 months:
70 ± 2.4 degrees
37
Bilateral AROM/PROM – Upper and Lower Extremities
Document infant’s natural movements Passively move arms and legs through all available range at each joint Passively move ribs and spine
38
Bilateral AROM/PROM – Upper and Lower Extremities rule out:
Developmental dysplasia of hip (DDH): observe for symmetry and stability of hip, leg length symmetry, gluteal skin folds, hip scour test, Barlow and Ortolani Maneuvers Brachial plexus injuries or clavicle fractures Neurological impairments Hypermobility CNS lesions Scoliosis
39
Document any behaviors reflective of ____ reactions in the infant and child during the examination process
discomfort, or pain
40
Pain or Discomfort =
Pain is not typically associated with the initial presentation of CMT The FLACC is recommended to document baseline status The PT should work with the parents and caregivers to differentiate actual pain responses from discomfort or behavioral reactions to stretching, anxiety, or the stress of an unusual environment.
41
Skin Integrity =
Document skin integrity Symmetry of neck and hip skin folds Presence and location of SCM mass Size, shape and elasticity of SCM muscle and secondary muscles
42
Up to 90% of infants with CMT will also have ___
craniofacial asymmetry
43
Craniofacial Asymmetries and Head/Skull Shape:
Document cranial deformities, including plagiocephaly, brachycephaly, and dolichocephaly
44
Craniofacial asymmetries on the side of the torticollis may include:
smaller and elevated eye with changes in the orbit recession of the ipsilateral ear a reduced jaw height with malocclusion possible gum line asymmetry
45
Cranial Deformations =
Plagiocephaly Brachycephaly Dolichocephaly
46
Plagiocephaly –
most common type of infant flat head syndrome. Generally, the back of the baby’s head is flat on one side
47
Brachycephaly –
second most common type of flat head syndrome. The back of the head is flattened instead of curved
48
Dolichocephaly –
less common type of flat head syndrome The head is flattened on both sides
49
Severity Ratings: Plagiocephaly
Cranial Vault Asymmetry Index (CVAI): Mild: 3.7 Moderate: 5.2 Severe: 7
50
Severity Ratings: Brachycephaly
Cephalic Ratio (CR): Mild: 81-86 Moderate: 87-92 Severe: 92
51
Craniosynostosis vs Plagiocephaly
affect the shape of an infant's skull Premature closure of one or more cranial sutures Prevalence ranges from 0.4% to 0.07% Requires referral to neurosurgery
52
Plagiocephaly =
ipsilateral frontal bossing ispilateral displaced anteriorly ipsilateral occipitoparietal flattening contralateral occipital bossing
53
Craniosynostosis =
contralateral frontal bossing ispilateral displaced posteriorly ipsilateral occipitomastoic flattening ipsilateral occipital bossing contralateral bossing
54
Gross Motor Function
Test of Infant Motor Performance (TIMP) Alberta Infant Motor Scale (AIMS) Peabody Developmental Motor Scales (PDMS-2)
55
Test of Infant Motor Performance (TIMP):
0-4 months
56
Alberta Infant Motor Scale (AIMS):
0-18 months
57
Peabody Developmental Motor Scales (PDMS-2):
0-5 years *Gross Motor Subtests
58
Muscle Function Scale (MFS):
5. head very high above horizontal line - almost vertical position 4. head high above horizontal line and more than 45 degrees 3. head high above horizontal line but below 45 degrees 2. head slightly above horizontal line 1. head on horizontal line 0. head below horizontal line
59
Severity Level Classification
grade 1: early mild grade 2: early moderate grade 3: early severe grade 4: later mild grade 5: later moderate grade 6: later severe grade 7: later extreme grade 8: very late
60
grade 1: early mild
0-6 mo: postural preference OR passive cervical rotation difference < 15°
61
grade 2: early moderate
0-6 mo: passive cervical rotation difference between sides 15-30°
62
grade 3: early severe
0-6 mo: SCM mass OR passive cervical rotation difference between sides > 30°
63
grade 4: later mild
7-9 mo: postural preference OR passive cervical rotation difference < 15°
64
grade 5: later moderate
10-12 mo: postural preference OR passive cervical rotation difference < 15°
65
grade 6: later severe
7-9 mo: passive cervical rotation difference > 15° 10-12 mo: passive cervical rotation difference 15-30°
66
grade 7: later extreme
7-12 mo: SCM mass 10-12 mo: passive cervical rotation difference > 30°
67
grade 8: very late
12+ mo: SCM mass, any asymmetry, OR any passive cervical rotation difference
68
Treatment – First Choice
Neck PROM Neck & Trunk AROM Symmetrical Movement Development Environmental Adaptations Parent/Caregiver Education
69
Neck PROM –
Gentle stretching Should not be painful to baby and stopped if infant resists or parent perceives changes in breathing or circulation Each cheek on caregiver’s chest or floor.
70
Neck & Trunk AROM –
Exciting things to the non-preferred side. Tummy time, short spurts, total > 1hr/day.
71
Symmetrical Movement Development –
Both sides, both ways. Sidelying, rolling, reaching. Want bend and twist, not arching.
72
Environmental Adaptations–
Carry baby vs keeping them in holders, use towel rolls inside of swing or holder
73
Parent/Caregiver Education–
Alternate sides for holding, feeding and changing diaper
74
Discharge Criteria:
PROM within 5 degrees of the non-affected side Symmetrical active movement patterns Age-appropriate motor development No visible head tilt Parents/caregivers understand what to monitor as the child grows
75
Re-Assess:
3-12 months following discharge from PT intervention OR when the child initiates walking
76
Re-evaluation should include:
Positional preference Symmetry of movement Developmental milestones
77
Consult Primary Care:
1. When asymmetries of the head, neck, and trunk are not starting to resolve after 4-6 weeks of comprehensive intervention. 2. After 6 months of treatment with a plateau in resolution.
78
Cranial Reshaping Helmet?
Head shaping not improving with positioning 4-10 months old Length depends on severity
79
Examination includes:
infant history, routines, body structures/posture, strength and mobility
80
Use ___ to classify severity level
decision tree
81
Follow ___ interventions
first choice
82
Use discharge criteria for ___ and ___
developing goals plan of care

MSK 3 final (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions