Torticollis & Plagiocephaly Flashcards
(28 cards)
What is congenital muscular torticollis (CMT)?
- Postural deformity resulting from unilateral shortening & fibrosis of SCM
- Muscle tumor often evident visually or on palpation
- Evident at birth
What is the common presentation of CMT?
Head tilt to side of tight muscle/tumor with chin rotated away towards opposite shoulder
What is the incidence of CMT?
- 0.4-2%
- 12.5% incidence of hip dysplasia in babies with torticollis
How does the presentation of CMT vary?
- May have lump in SCM & restricted ROM, no lump & restricted ROM or positioning without restricted ROM
- 28-47% have a tumor
- Tumor resolves over 5-21 months
What is the aetiology of CMT?
- Unknown
- Possibly associated with ischaemia, birth trauma, intrauterine positioning of head, compartment syndrome
What is the aetiology of prenatal deformational plagiocephaly?
- Moulding forces induced by inutero constraint
- Compression of fetal skull between maternal pelvic bone and lumbar sacral spine
What is the aetiology of acquired deformational plagiocephaly?
- Develops in the first 3 months
- Non synostotic plagiocephaly
- Peak prevalence at 4 months
What risk factors are associated with plagiocephaly?
- Oligohydramnios
- Uterine malformation
- Cephalohaemotoma
- Complicated birth / assisted delivery
- Primiparity
- Male
- CMT/infant neck problems
What are the differential diagnoses of plagiocephaly?
- Skeletal abnormalities
- Pterygium colli (web of skin from acromion to mastoid)
- Occular torticollis (head tilt but no restriction in ROM)
- Brachial plexus lesions
- Posterior fossa pathology
- Arnold Chiari malformation & syringomyelia
What are some of the skeletal abnormalities that may be differential diagnoses for plagiocephaly?
- Unilateral lambdoid or coronal craniosynostosis
- Congenital anomalies of occipital condyles & cervical spine
- Klippel-Feil syndrome (fusion of cervical vertebrae)
What does the subjective assessment of CMT & plagiocephaly include?
- Prenatal/birth history
- Side of ?CMT/head preference
- Other congenital abnormalities, medications
- X-rays or imaging
- Age of diagnosis/concerns
- Time in play, care & sleep positions
- Feeding issues
- Parental current concerns
What does the objective assessment of CMT & plagiocephaly include?
- Resting head position
- Palpation of mm for tumor and tone
- Cervical spine AROM/PROM
- Skin creases
- UL & shoulder girdle function
- In older infants trunk & LL screened for weight shift and weight bearing
- Spinal motion/mobility
What should be screened when assessing CMT & plagiocephaly?
- Hip asymmetry
- Vision & hearing
- Motor development
How can skull shape be assessed?
- Photos
- Tape measure
- Callipers
- Bendy rulers
- Charts
- Digital devices with software analysis
- Radiological imaging
- 3D scanning devices
What should be observed when assessing skull shape?
- Occipital/parietal, frontal/temporal flattening
- Bulging parietal area,
- Bossing of frontal area
- Head height differences
- Ears, eyes and cheek size & alignment
- Mandible position & TMJ function
- Facial mm asymmetry
What are the physio treatment strategies for CMT & plagiocephaly?
- Early diagnosis & intervention
- Physio between 3-6 months
- Identify impairments & develop treatment plan
- Advice
- Handling
- Positioning (sleep supine, play sidelying/prone/sitting)
- HEP for ROM, passive stretching & developmental stimulation
What are the goals of early physio treatment?
- Restore full neck movement as early as possible
- Stop skull base deformity
- Prevent craniofacial asymmetry
- Prevent bony & postural changes
When can active exercises be included as treatment for CMT & plagiocephaly?
- Once infant has active head control (approx 4 months)
- Exercises use tracking of toys/mirror to encourage cervical rotation
When should passive stretches be performed?
With every nappy change
What are the guidelines for helmet therapy?
- Start at 3-4 months
- 15-22 hours per day
What evidence is there for physio for asymmetric head shape in infants <3 months?
- Repositioning & physio effective if <3 months
- Most successful in 2nd-4th week of age (skull most malleable)
What evidence is there for physio for asymmetric head shape in infants >3 months?
- At 4-6 months, continue physio & repositioning if mild-mod
- Consider orthotic for severe
What evidence is there for treatment of asymmetric head shape in CMT?
- 90-100% of infants who receive early physio report resolution of symptoms before 1 year old
What are the consequences of untreated CMT?
- Progressive limitation of cervical movement
- Craniofacial asymmetry
(including mandibular hypoplasia) - Plagiocephaly
- Compensatory scoliosis
- Delayed early motor milestones
- Functional asymmetry similar to hemiplegia
