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731: Pediatrics > Torticollis and Plagiocephaly > Flashcards

Torticollis and Plagiocephaly Flashcards

1
Q

Define congenital muscular torticollis (CMT)

A

Unilateral shortening of the sternocleidomastoid (SCM) muscle

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2
Q

Describe the presentation of an infant with CMT

A

Lateral flexion on the ipsilateral side of the shortened SCM and rotation of the head away from the side

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3
Q

Pseudo-facial drooping also tends to occur in infants with CMT, what side does this occur to?

A

contralateral side

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4
Q

While shortening of the SCM may be the primary muscle involved, secondary shortening occurs in what other muscles?

A
  • scalenes
  • levator scapulae
  • upper trap
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5
Q

When is CMT usually noted in affected children?

A

2 to 3 weeks after birth

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6
Q

Describe the proposed etiology of CMT

A

Specific cause is unknown, however it is associated with the formation of a mass or fibrotic tumor within the SCM

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7
Q

Describe 2 possible hypotheses behind the formation of the fibrotic mass

A
  • Intrauterine malposition (breeched)

- Complicated delivery

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8
Q

Intrauterine malpositioning results in what that can result in anoxic injury to the SCM muscle?

A

occlusion of blood vessels

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9
Q

In regards to birth order what child is the most susceptible to torticollis?

A

first born

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10
Q

Babies born heavier than _lbs _oz have been associated with increased risk for torticollis

A

9 lbs 9 ounces

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11
Q

What are the 3 classifications of CMT?

A
  • SCM tumor
  • Muscular torticollis (MT)
  • Positional torticollis (POST)
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12
Q

When is CMT classified as an SCM tumor?

A

When there is a palpable mass within the SCM

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13
Q

When is CMT classified as an muscular torticollis?

A

When contracture of the SCM muscle is present but no palpable mass is present

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14
Q

When is CMT classified as an positional torticollis?

A

When both contracture of the SCM muscle and a palpable mass are absent

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15
Q

Define plagiocephaly

A

flattening of the infants skull on one side

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16
Q

Other than what has already been mentioned what is a possible cause of torticollis?

A

Babies are placed in supine to sleep due to increased SIDS risk and begun to develop plagiocephaly which leads to torticollis

17
Q

Conservative treatment of CMT is generally recommended for infants __ months and younger

A

12

18
Q

What does the conservative management of congenital muscular torticollis include?

A
  • Prolonged passive stretching of the SCM muscle
  • Active cervical ROM with subsequent strengthening exercises
  • Symmetric developmental activities to correct head position, neck, and UE positioning
19
Q

How can passive SCM stretching be achieved?

A

through positioning and handling techniques

20
Q

How should active cervical ROM be accomplished in children less than 4 months?

A

visual tracking of objects

21
Q

How should active cervical ROM be accomplished in children older than 4 months?

A

equilibrium and righting reactions and developmental play

22
Q

What orthotic device may be beneficial to help maintain ROM?

A

TOT Collar

23
Q

When is a TOT collar recommended?

A

For infants at least 4 months old with consistent head tilt of 5 degrees or more for more than 80% of the day who perform all movements with a head tilt

24
Q

Before surgical intervention should be considered what is another conservative treatment idea?

A

Botox injection in combination with PT

25
Q

Surgical intervention is indicated under what 2 conditions?

A
  • there has been no progress after 6 months of conservative treatment
  • the infant displays a residual head tilt and exhibit deficits of passive rotation and lateral flexion of the neck greater than 15 degrees
26
Q

What should be used to treat plagiocephaly?

A

a cranial orthosis

27
Q

What is the most commonly used cranial orthosis?

A

Dynamic Orthotic Cranioplasty (DOC) band

28
Q

How does the DOC band work?

A

It applies pressure to the anterior and posterior prominences of the cranium but allows growth in the flattened areas

29
Q

A DOC band is recommended in childen ages _-__ months of age

A

3-12

30
Q

How many hours of the day is a DOC band worn?

A

23-24

31
Q

What happens if CMT is unresolved?

A
  • cervical scoliosis with compensatory thoracic curvature
  • ocular impairments
  • vestibular impairments

731: Pediatrics (19 decks)

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