PHS302 - Torticollis

PHS302 - Torticollis

1. congenital muscular torticollis

   • palpable sternomastoid tumour
     • olive-like lump in distal 3rd of sternal head
   • no palpable SMT but tight SCM
   • commonly due to unilat shortening of SCM
   • aetiology
     • mal-posn in utero or birth trauma
     • fibrosed SCM
   • knock on effect on child
     • cranial / facial asymmetry
     • poor development of vision sec to attending to one side only
     • poor feeding - TMJ alignment and dental issues
     • delayed development of symmetry at 4m
     • dec use and awareness of hand on occipital side

2. postural torticollis

   • no palpable SMT, no tightness in SCM and all other causes eliminated

3. Assessment

   • preferred position and posture (supported sitting, supine, prone)
   • AROM / PROM (SSP) - UL / LL against gravity
   • head control - supine to prone and lifted head in SL
   • pain / discomfort
   • skin integrity
   • craniofacial asymmetry
   • measurement
     • photographic
     • percentage of time spent in preferred posn
     • measurement range - arthrodial protractor
       • lateral flexn measure
     • muscle fx scale for lateral flexn
       • posn of head in relation to horizontal against gravity L vs R
     • Argenta scale for head shape
     • classify severity
       • deg of mm tightness => grading => decision re intervention
   • screening
     • MSK - head shape, symmetry of shldrs and hips, hip dysplasia, neck ROM, feet
     • HEAD, HIPS, FEET
     • Neurological - tone, refexes, limb ROM, developmental milestones (AIMS), visual screen
     • skin - skin fold symmetry, hips and cervical region
     • cardiorespiratory
     • GI history

4. RED FLAGS

   • SUSPECTED HIP DYSPLASIA
   • SKULL AND/OR FACIAL ASYMMETRY, INCL PLAGIOCEPHALY/BRACHYCEPHALY
   • ATYPICAL PRES - TILT & TURN TO SAME SIDE, OR PLAGIOCEPHALY & TILT TO SAME SIDE
   • ABNORMAL TONE
   • LATE-ONSET TORTICOLLIS AT 6/12 OR OLDER

5. Management

   • provide info to parents
   • RX what find, but refer to guidelines
   • HEP - active and passive ex's - fx
     • active strengthening - age approp
     • positioning and handling
       • righting reactions
       • approach from non-affected side
       • tummy time - wedge
       • rotation stretches
       • rolling
       • lateral flxn stretches
   • promote age approp motor milestones
   • passive stretches - if mm tightness present
   • incorpororate symmetry into all