torticollis and plagiocephaly Questions and Answers
2024
what is congential muscular torticollis **** -"twisted" posture of head and neck in
infancy due to unilateral shortening of SCM
what side torticollis is more common **** R sided (so R SCM involvement)
etiology of torticollis **** -ischemia
-birth trauma
-interuterine malpositioning
-back to sleep campaign??
incidence of CMT **** about 16% of new borns
-this is the 3rd most common MSK anomaly, after hip dysplasia and club foot
risk factors of CMT **** -large birthweight
-multiple birth
-male gender
-breech position (butt down)
-difficult labor and delivery
-reflux
non muscular etiologies of torticollis postures that could be other differential diagnoses
**** -klippel-feil sundrome; fusion of 2 cervical vertebrae
-ocular lesion
-sandifer syndrome - reflux and spasm
-arnold chiari malformation
-brachial plexus injury and/or clavicle fx
body structure changes with CMT **** -shortened SCM
-decreased ipsilateral rotation
-decreased contralateral SB
-compensatory ipsilateral shoulder hiking
-plagiocephaly
what is plagiocephaly **** skull and facial asymmetries
how common is plagiocephaly with torticollis **** 80-90% of cases
if have L sided CMT what are the limited motions and facial abnormalities seen **** -
limited L rotation
-limited R SB
, -L shoulder hike
-R occiput flattened
-L eye smaller
-L ear more inferior and posterior
body function changes seen with CMT **** -muscle strength imbalance
-asymmetrical movement of head dt asymmetrical righting reactions
-decreased awareness/ neglect of ipsilateral body/ visual field
muscle strength imbalance seen with CMT **** functional scoliosis with curve
toward involved SCM
activity lmiitations with CMT **** -atypical motor milestone development
-delayed rolling to ipsilateral side
-asymmetrical weight bearing affecting sitting, creeping, walking, transitions
participation restrictions with CMT **** -restricted abiltiy to explore and learn through
visual tracking/ focus and bilateral hand use
-restricted ability to engage with caregivers through visual tracking/ focus and bilateral
hand use
-in rare cases have restricted ability to take in nutrients
environmental factors impacting plan of care for CMT **** -resources.. if they have
access to healthcare, transportation, money, etc
-the childs caregivers awareness/ understanding of the problem, mental health, follow
through with exercises, parent-child relationship, and support system
personal factors impacting plan of care for CMT **** -age at presentation (early tx is
key)
-babyes personality and response to intervention
-other health issues such as sleeping and feeding
specific factors to get information on during medical history and parent interview ****
-age at initial visit
-age of symptom onset
-pregnancy history
-delivery history including birth presentation and use of assistance
-head posture/ preference
-how are they feeding/ sleeping
-otehr known or suspected medical conditions
-developmental milestones
-images and medical reports if available
what to focus on for systems review for CMT and for what **** -vision (ocular
torticollis)
-GI (sandifer syndrome)
2024
what is congential muscular torticollis **** -"twisted" posture of head and neck in
infancy due to unilateral shortening of SCM
what side torticollis is more common **** R sided (so R SCM involvement)
etiology of torticollis **** -ischemia
-birth trauma
-interuterine malpositioning
-back to sleep campaign??
incidence of CMT **** about 16% of new borns
-this is the 3rd most common MSK anomaly, after hip dysplasia and club foot
risk factors of CMT **** -large birthweight
-multiple birth
-male gender
-breech position (butt down)
-difficult labor and delivery
-reflux
non muscular etiologies of torticollis postures that could be other differential diagnoses
**** -klippel-feil sundrome; fusion of 2 cervical vertebrae
-ocular lesion
-sandifer syndrome - reflux and spasm
-arnold chiari malformation
-brachial plexus injury and/or clavicle fx
body structure changes with CMT **** -shortened SCM
-decreased ipsilateral rotation
-decreased contralateral SB
-compensatory ipsilateral shoulder hiking
-plagiocephaly
what is plagiocephaly **** skull and facial asymmetries
how common is plagiocephaly with torticollis **** 80-90% of cases
if have L sided CMT what are the limited motions and facial abnormalities seen **** -
limited L rotation
-limited R SB
, -L shoulder hike
-R occiput flattened
-L eye smaller
-L ear more inferior and posterior
body function changes seen with CMT **** -muscle strength imbalance
-asymmetrical movement of head dt asymmetrical righting reactions
-decreased awareness/ neglect of ipsilateral body/ visual field
muscle strength imbalance seen with CMT **** functional scoliosis with curve
toward involved SCM
activity lmiitations with CMT **** -atypical motor milestone development
-delayed rolling to ipsilateral side
-asymmetrical weight bearing affecting sitting, creeping, walking, transitions
participation restrictions with CMT **** -restricted abiltiy to explore and learn through
visual tracking/ focus and bilateral hand use
-restricted ability to engage with caregivers through visual tracking/ focus and bilateral
hand use
-in rare cases have restricted ability to take in nutrients
environmental factors impacting plan of care for CMT **** -resources.. if they have
access to healthcare, transportation, money, etc
-the childs caregivers awareness/ understanding of the problem, mental health, follow
through with exercises, parent-child relationship, and support system
personal factors impacting plan of care for CMT **** -age at presentation (early tx is
key)
-babyes personality and response to intervention
-other health issues such as sleeping and feeding
specific factors to get information on during medical history and parent interview ****
-age at initial visit
-age of symptom onset
-pregnancy history
-delivery history including birth presentation and use of assistance
-head posture/ preference
-how are they feeding/ sleeping
-otehr known or suspected medical conditions
-developmental milestones
-images and medical reports if available
what to focus on for systems review for CMT and for what **** -vision (ocular
torticollis)
-GI (sandifer syndrome)
