Congenital Muscular torticollis
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What is CMT?
Wry neck, the contracted state of the sternocleidomastoid muscle. Lateral flexion to the affected side with rotation of the chin to the opposite side. Named by the involved side.
Four types of CMT?
- Type I (15%) - fibrotic mass in SCM
- Type II (77%) diffuse fibrosis mixed with normal muscle
- Type III (5%) fibrotic tissue without normal muscle
- Type IV (3%) fibrotic cord
Not to be confused with cervical dystonia (CNS) involvement.
Incidence of CMT?
the 3rd most common congenital musculoskeletal anomaly. Incidence reports vary from .3% - .6% of newborns or .6-400 per 100,000 live births. COMMON.
What typically coexists with CMT?
Plagiocephaly, 80-91% of the time
Cause of CMT?
Unkown, theories: brith trauma, restrictive uterine encironment, poor muslce tone, cervical vertebral abnormalities, genetic component, venous or arterial occlusion.
Surgical interventions for CMT?
rare and only in severe cases, indicated if the child has restriction of 30 degrees or greater, after 6 months of therapy or the deformity persists longer than 12 months or the deformity increases or increased thickening of the SCM is noted. Postoperative bracing is necessary after surgery.
Clinical manifestations of CMT?
Cervical lateral flexion (involved side), cervical rotation (opposite side), may or may not see or palpate a firm, non-tender enlargement of the SCM (tumor).
Clinical manifestations of SEVERE CMT?
- Ipsilateral mandibular asymmetry
- ear displacement
- pelvic asymmetry
- hip dislocation
- foot deformity
Positioning PT management of CMT?
want the neck and trunk in midline all the time. car seatt, holding/cuddling, feeding
** MOST important
Stretching/ROM for PT management of CMT?
needs to be gentle, slow and through positioning and handling. Need to not only stretch the involved side but also the anterior and posterior muscles. Can use orthotics (tubular orthosis for torticollis aka TOT collar) to further assist.
Strengthening PT management of CMT?
through play and positioning. Needs to be spaced out throughout the day to avoid fatigue and poor motor planning. Need to strengthen the uninvolved side to over come the involved SCM contracture. Can use kinesiotape to assist.
Gross motor facilitation PT management of CMT?
need to monitor gross motor development for delays, asymmetrical movements and neglect. Monitor child until independently walking.
HEP for PT management of CMT?
Provide family with written instructions. Pictures are helpful, incorporate stretching and strengthening into daily routine (diaper changes, feeding etc.)
When will children with CMT appear worse and what should you do?
when teething, sick, tired, growing, developing a new gross motor skill.
warn the family of this and continue with HEP
If a child with CMT is not responding to therapy or the side of lateral flexion changes, what could it be and what should you do?
- GI related
- cervical subluxation
should refer them back to pediatrician or specialist
prognosis of CMT?
if identifies and treated early a full recovery can be expected. 3-12 months for full recover.
if left untreated the deformity and asymmetry will persist and progress leading to additional orthopedic and medical complication.
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