Pediatric Torticollis: A Note Taking Guide PDF

Slide Deck 2.3: Torticollis Condition Abnormal position of head and neck Common in infants Prefer to turn head to one side Problems turning head to other side May tilt head to one side: with one ear closer to shoulder Noticeable in car seat or in photos Head may be misshaped Flattening or bulging on...

Slide Deck 2.3: Torticollis Condition Abnormal position of head and neck Common in infants Prefer to turn head to one side Problems turning head to other side May tilt head to one side: with one ear closer to shoulder Noticeable in car seat or in photos Head may be misshaped Flattening or bulging on head back or side; plagiocephaly One ear is forward Muscle tightness can change shape of facial features on one side of face Cheek may appear fuller on one side, one eye may be “more open” Open mouth with an uneven jaw Behavior May become fussy when you try to change position of head or when placed on tummy because they are not able to lift or turn their head Etiology Tightness in sternocleidomastoid on one side of neck 3 Types: o Congenital Muscular Torticollis: mass/nodule in muscle, tightness in other neck or shoulder muscles o Acquired Torticollis: Soft tissue or bony abnormalities o Positional Torticollis Severity o Postural, mildest: postural preference of head and neck by head and neck of infant without limitations to PROM and without a nodule in muscle o Muscular: unilateral tightness of SCM during cervical rotation and/or lateral flexion, no muscular nodule o SCM Nodule, most severe: presents with a palpable nodule/ fibrous bands in SCM and limitations in either or both cervical rotation and lateral flexion Incidence and Prevalence CMT: Incidence- 3rd most common congenital musculoskeletal condition Cranial Deformity (CD)- co-exists in 90.1% of infants with CMT; increases risk of facial, ear/mandible asymmetry Prenatal factors that cause CMT: ischemic injury due to head position in utero causing compartment syndrome, intrauterine crowding, infective myositis, rupture of muscle Perinatal factors that cause CMT: birth trauma from breech position or assisted deliveries Postnatal factors that cause CMT: positional preference Etiology of CD attributed to: intrauterine deformation that worsens after birth; postnatal positioning; CMT Factors associated with increased risk: o male gender o firstborn o delivered w/ forceps/vacuum o supine positioning (Back to Sleep program to reduce risk of SIDS) o neck problems o infrequent tummy time o bottle feeding in same arm o consistent positioning in a crib Theorized to result from uterine constraint perpetuated postnatally with preferential supine position on flat area of the skull Earlier motor skill achievements may prevent CD; less activity or developmental delays increase risk Increasing incidence until 4 months when infants can hold their heads upright, thereafter decreased incidence until 2 years of age Impairments Decreased visual tracking toward ipsilateral side Altered midline perceptual motor coordination Decreased prone tolerance Asymmetrical head turning Delayed rolling Asymmetrical/delayed protective and righting reactions Side of bottle feeding Visual preference to one side Preferential head turning during sleep Associated Conditions mandibular asymmetry craniofacial asymmetry including deformational plagiocephaly eye and mouth displacement scoliosis brachial plexus injury pelvic asymmetry congenital hip dysplasia foot deformity muscle and functional asymmetry greater use of related services in early school years Summary Definition Etiology Abnormal position of head and neck Types -Congenital Muscular Torticollis; Thickening or lump in affected muscle; Tightness in neck or shoulder muscles -Acquired Torticollis; Soft tissue or bony abnormalities -Positional Torticollis; Baby’s position when sleeping on back; positions throughout day Alterations in Body Functions and Structures Potential Activity Limitations and Participation Restrictions Prefer to turn head to one side May tilt head to one side Decreased ROM Head asymmetry Difficulty with visual tracking to contralateral side of the posterior flattening/misshaped head, especially when supine or reclined, difficulty fitting glasses if ear asymmetry Head may be misshaped or flattened Potential Management PT highly effective at resolving when initiated in early infancy PT Goal: prevent limitations and deformity by repositioning to facilitate symmetrical movement and head shaping Summary Abnormal position of head and neck Prefer to turn head to one side May tilt head to one side PT highly effective initiated in early infancy PT Goal: prevent limitations and deformity by repositioning to facilitate symmetrical movement and head shaping