PHS302 - Torticollis

congenital muscular torticollis
1. palpable sternomastoid tumour
  1. olive-like lump in distal 3rd of sternal head
2. no palpable SMT but tight SCM
3. commonly due to unilat shortening of SCM
4. aetiology
  1. mal-posn in utero or birth trauma
  2. fibrosed SCM
5. knock on effect on child
  1. cranial / facial asymmetry
  2. poor development of vision sec to attending to one side only
  3. poor feeding - TMJ alignment and dental issues
  4. delayed development of symmetry at 4m
  5. dec use and awareness of hand on occipital side
postural torticollis
1. no palpable SMT, no tightness in SCM and all other causes eliminated
Assessment
1. preferred position and posture (supported sitting, supine, prone)
2. AROM / PROM (SSP) - UL / LL against gravity
3. head control - supine to prone and lifted head in SL
4. pain / discomfort
5. skin integrity
6. craniofacial asymmetry
7. measurement
  1. photographic
  2. percentage of time spent in preferred posn
  3. measurement range - arthrodial protractor
    1. lateral flexn measure
  4. muscle fx scale for lateral flexn
    1. posn of head in relation to horizontal against gravity L vs R
  5. Argenta scale for head shape
  6. classify severity
    1. deg of mm tightness => grading => decision re intervention
8. screening
  1. MSK - head shape, symmetry of shldrs and hips, hip dysplasia, neck ROM, feet
  2. HEAD, HIPS, FEET
  3. Neurological - tone, refexes, limb ROM, developmental milestones (AIMS), visual screen
  4. skin - skin fold symmetry, hips and cervical region
  5. cardiorespiratory
  6. GI history
RED FLAGS
1. SUSPECTED HIP DYSPLASIA
2. SKULL AND/OR FACIAL ASYMMETRY, INCL PLAGIOCEPHALY/BRACHYCEPHALY
3. ATYPICAL PRES - TILT & TURN TO SAME SIDE, OR PLAGIOCEPHALY & TILT TO SAME SIDE
4. ABNORMAL TONE
5. LATE-ONSET TORTICOLLIS AT 6/12 OR OLDER
Management
1. provide info to parents
2. RX what find, but refer to guidelines
3. HEP - active and passive ex's - fx
  1. active strengthening - age approp
  2. positioning and handling
    1. righting reactions
    2. approach from non-affected side
    3. tummy time - wedge
    4. rotation stretches
    5. rolling
    6. lateral flxn stretches
4. promote age approp motor milestones
5. passive stretches - if mm tightness present
6. incorpororate symmetry into all

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PHS302 - Torticollis

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	Created by Louise Weir about 8 years ago