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Purpose:
To present 2 cases with severe congenital muscular torticollis and describe postsurgical physical therapy management.
Description:
Two children diagnosed with severe congenital muscular torticollis underwent surgical release of the involved sternocleidomastoid muscle with subsequent physical therapy. Presurgical examination findings, su...
Citations
... In medical practice, physiotherapists use A study using CMT clinical practice guideline (CPG) suggested similar management for non-operative CMT treatment. 27 A study was conducted in 2005 to help relieve the patient's cervical musculature on the affected side after finding symptoms of weakness on the uninvolved SCM. 28 When compared to a research in 2018, the outcomes of the study showed that physiotherapeutic intervention through STM is beneficial in CMT management and speeds up recovery. ...
Congenital muscular torticollis is a problem that arises at birth or immediately after birth in which the sternocleidomastoid muscle is shortened on the afflicted side, leading to an ipsilateral rotated of the head and a contralateral rotated of the face and jaw. To determine the effectiveness of physical therapy treatment in infants treated for congenital muscular torticollis, relevant articles published between 2011 and 2020 were located using electronic databases. A total of 9 studies out of 24 potentially relevant articles were reviewed. All studies were randomised controlled trials with 6-8 score on the Physiotherapy Evidence Database scale (Pedro scale) which showed high quality of methodology. The studies typically found significant statistical effects in the management of congenital muscular torticollis. Additionally, most of the studies reported increased adherence to exercise as another essential advantage. Conservative physical therapy management showed positive outcomes, and early physiotherapy referral showed significant reduction in treatment duration.
Key Words: Conservative management, Congenital muscular torticollis, Infants, Paediatric physiotherapy, Physical therapy.
A sternocleidomastoid (SCM) tumor is an uncommon congenital tumor in one of the two SCM neck muscles, although bilateral cases have also been reported. This lesion is extremely rare but is the most common cause of congenital muscular torticollis (10–20% of cases). The different theories proposed to explain the pathogenesis of SCM tumors include birth trauma, fetal malposition, ischemic necrosis, infection, and the presence of endogenous factors. This tumor most commonly presents as a slow-growing, firm, mobile, non-tender, spindle-shaped mass in the middle or lower two-thirds of the SCM muscle of infants at birth or in the first 8 weeks. The mother may notice a lump or that the child keeps the head turned to one side due to SCM contracture. The recommended first step after a clinical diagnosis is Doppler ultrasonography (US) combined with Duplex US. These tumors are typically diagnosed by fine needle aspiration cytology rather than the more invasive approach of tumor biopsy. Prompt diagnosis and treatment is crucial for avoiding the impairments that may follow long-term malpositioning of the infant’s head such as permanent facial asymmetry, flattened head, loss of neck mobility, and scoliosis. This chapter discusses the causes, pathogenesis, clinical presentation, pathological findings, diagnosis, and differential diagnosis of SCM tumors, in addition to treatment options (conservative/surgical) and prognosis. It also addresses the diagnosis and management of bilateral SCM tumors.KeywordsLateral neckSwellingSternocleidomastoidTumorTorticollisBirth traumaFetal mal-positioningIschemic necrosisTenotomy
Congenital muscular torticollis (CMT) is a common congenital musculoskeletal problem. It presents within the first few weeks of life and is due to a unilateral contracted or shortened sternocleidomastoid muscle (SCM). Characteristic features of the deformity include the infant’s head tilted towards the affected side and its chin rotated towards the contralateral side. There may also be a palpable mass present within the SCM muscle. The diagnosis is made clinically via a medical history and physical examination and can be verified with cervical X-ray and ultrasound, when necessary. Children should be screened for DDH and plagiocephaly, as these have a high association with CMT. Most cases of CMT will resolve with conservative management of physical therapy and manual stretching. When a patient has refractory CMT, residual range of motion deficits, or late presentation after 1 year of age, surgical intervention may be required. This procedure entails releasing the SCM muscle to lengthen it in order to restore normal neck range of motion.
Background:
Congenital muscular torticollis (CMT) is a postural deformity evident shortly after birth, typically characterized by lateral flexion/side bending of the head to one side and cervical rotation/head turning to the opposite side due to unilateral shortening of the sternocleidomastoid muscle; it may be accompanied by other neurological or musculoskeletal conditions. Infants with CMT should be referred to physical therapists to treat these postural asymmetries as soon as they are identified.
Purpose:
This update of the 2013 CMT clinical practice guideline (CPG) informs clinicians and families as to whom to monitor, treat, and/or refer and when and what to treat. It links 17 action statements with explicit levels of critically appraised evidence and expert opinion with recommendations on implementation of the CMT CPG into practice.
Results/conclusions:
The CPG addresses the following: education for prevention; referral; screening; examination and evaluation; prognosis; first-choice and supplemental interventions; consultation; discontinuation from direct intervention; reassessment and discharge; implementation and compliance audits; and research recommendations. Flow sheets for referral paths and classification of CMT severity have been updated.
Purpose:
To systematically review the recent evidence on physical therapy (PT) diagnosis, prognosis, and intervention of congenital muscular torticollis to inform the update to the PT management of congenital muscular torticollis evidence-based clinical practice guideline.
Methods:
From 2012 to 2017, 7 databases were searched for studies that informed PT diagnosis, prognosis, or intervention of infants and children with congenital muscular torticollis. Studies were appraised for risk of bias and quality.
Results:
Twenty studies were included. No studies informed PT diagnosis. Fourteen studies informed prognosis, including factors associated with presence of a sternocleidomastoid lesion, extent of symptom resolution, treatment duration, adherence to intervention, cervical spine outcomes, and motor outcome. Six studies informed intervention including stretching frequency, microcurrent, kinesiology tape, group therapy, and postoperative PT.
Conclusions:
New evidence supports that low birth weight, breech presentation, and motor asymmetry are prognostic factors associated with longer treatment duration. Higher-level evidence is emerging for microcurrent intervention.
