Congenital Muscular Torticollis

what is torticollis

- shortening of the SCM that results in ipsilateral lateral flexion and contralateral rotation

- ipsilateral tightness, contralateral weakness

subjective patient history

- birth history (forceps, position, multiple birth)

- developmental skills (i.e. prone tolerance)

- feeding

- positioning devices and hours per day (car seat, swing, bouncy seat, etc)

- position for sleeping/while awake

PT exam

- visual tracking (rescreen at 4 months)

- neuro screen

- hip screen

- cervical PROM/AROM

- active/passive UE and LE

- posture

- developmental skills

- head righting

- muscle function scale

- head shape

- palpation

- standardized tests (ASQ-3)

0 on muscle function scale (MFS) for infants

head below horizontal line

1 on muscle function scale (MFS) for infants

head in the horizontal line

2 on muscle function scale (MFS) for infants

head slightly over the horizontal line

3 on muscle function scale (MFS) for infants

head high over horizontal line but <45 degrees

4 on muscle function scale (MFS) for infants

head high over horizontal line and >45 degrees

5 on muscle function scale (MFS) for infants

head very high over horizontal line, almost vertical position

PT intervention

- ROM (neck AROM/PROM, trunk AROM)

- positioning/environmental adaptations (sleeping, bottle feeding, car seat, room objects)

- strengthening (lateral neck righting, tummy time)

- development of symmetrical movement

- parent/caregiver education

- TOT collar/Benik (helps child maintain cervical midline)

- kinesiotape can be used to cue contralateral SCM or to help relax ipsilateral shoulder

- traditional massage

- microcurrent (used for more severe cases)

- soft tissue mobilization

PT goals

- PROM, AROM

- head position

- MFS scores

- symmetry

treatment frequency - typical protocol

- weekly until full AROM and PROM achieved

- follow up at time of walking