Congenital muscular torticollis physiotherapy management · 5. Asymmetrical or abnormal reflexes...
Transcript of Congenital muscular torticollis physiotherapy management · 5. Asymmetrical or abnormal reflexes...
National University
Faculty Of Physiotherapy
Third Year - Semester - 6 - Batch (12)
Paediatrics Physiotherapy
Congenital muscular torticollis
Lana Satti Osman
0912456667
Definition
Congenital muscular torticollis also called twisted neck or wryneck, is a
condition in which an infant holds his head and neck tilted to one side and
the chin is rotated to opposite side. In CMT the muscle that extends goes
diagonally across the neck , the sternocleidomastoid muscle is tight and
shortened.
Types of muscular torticollis
1) Congenital torticollis
2) Acquired torticollis
Causes of congenital muscular
torticollis
The main cause is unknown however it may be related to:
1. Abnormal positioning ( breech position ) or “ crowding” of the baby while in the uterus.
2. Muscle trauma or injury during a difficult delivery.
3. Soft tissue compression in the neck due to positioning in the uterus.
4. Congenital abnormalities of soft tissues with in SCM muscle.
5. Abnormality of blood supply to the fetus.
Note: torticollis can be caused rarely by vertebral abnormalities (e.g. hemiatlas). The deformity is rigid and resists any passive correction.
Pathology:
Trauma …….. Bleeding into SCM muscle……….hematoma formation…………lead to scare
tissue formation………….. Replaced by fibrous tissue.
Intrauterine position of the head will make the muscle short and eventually fibroses.
Symptoms
1. The head tilts to one side and the chin points to the opposite shoulder. ( Rt
side is most affected).
2. Limited range of motion in the neck.
3. Small mass is usually present in the middle or lower third of the SCM
muscle. On palpation there is hard non tender, fusiform swelling or tumor
in SCM muscle.
Diagnosis
The diagnosis of torticollis is usually made by the pediatrician in the first 2 or
3 months of life when a pseudo tumor of SCM muscle, characteristic cord
like appearance of the muscle, abnormal head posture and restricted
cervical ROM.
Prognosis
CMT is not a life threatening condition. Early diagnosis is helpful and it
correct spontaneously. One of the complications that if not treated; might
develops is compression on the nerve roots.
Physiotherapy evaluation
1. History taking.
2. Observation.
a. Position of the head in relation to trunk and limbs.
b. The degree of the facial asymmetry by turning the head to mid position.
c. Inspection of the skin over the neck for folds asymmetry.
d. Observation of the infants abilities “ age appropriate motor skills”.
e. Postural assessment for the entire spine.
3. Palpation
4. PROM & AROM.
5. Asymmetrical or abnormal reflexes should be tested.
6. Measuring the size of the tumor.
7. Lower extremities should be examined for hip dislocation and other associated problems . There is 20% incidence of hip dislocation in children with torticollis.
Physiotherapy goals
1. Stretch the tight muscles.
2. Strengthen the contralateral SCM muscle and neck muscles.
3. Prevent development of contracture.
4. Prevent delay of normal neck activities.
5. Encourage normal posture.
6. Facilitate normal righting reactions.
Physiotherapy treatment
Treatment should start as soon as the diagnosis is made. The treatment
consist of the following:
1. Positioning
2. Gentle PROM
3. Strengthen exercises
4. Stretching exercise
5. Facilitation of the age appropriate skills
6. Orthotics
7. Home routine
Surgical treatment
Surgical release of the SCM muscle is required when:
1. When children don’t respond to conservative treatment within one year.
2. In neglected cases until the age of one year.
3. When the parents haven't complied in performing an effective exercise
regimen.
Post operative PT management:
1. Immediately after surgery child lies without pillow, sand bag is used to
prevent returning of the head.
2. Stretching starts after 36 hours from surgery.
3. Strengthen exercise and
4. orthosis may be prescribed.
Cap and jacket splint Tubular orthosis