PROGNOSTIC SIGNIFICANCE OF ELECTROMYOGRAPHY IN CONGENITAL TORTICOLLIS

Abstract

The selection of the patients with congenital muscular torticolis for early surgical treatment is of paramount importance because in severe cases the deformity is progressive, and surgical treatment produces the best results when the diseased and restraining muscle is removed in early infancy. Electromyography appears to be of some value as an adjunct to clinical evaluation in determining which patient should have such early surgical treatment. The electromyogram permits the physician to obtain an objective estimate of the amount of destruction present in any given muscle. If few muscle fibers are working, he may conclude that the muscle has been replaced by fibrous tissue and that structural deformities are likely to progress due to the disproportionate growth of the diseased area in comparison to the surrounding normal boney and soft tissues. Conversely, if there are many normal muscles fibers functioning within the mass he may predict a more favorable outcome in terms of muscle length and function and consequently less deformity in the future. Our observations to date indicate that if there is a severe reduction in electrical activity of the involved sternoleidomastoid muscle, as indicated by the electromyogram, the histologic studies will show evidence of extensive destruction of normal muscle and replacement with scan tissue. In such a patient early surgical excision is probably justified. Conversely, if there is minimal or moderate reduction in electrical activity, conservative management with physical therapy and repeated observations is the treatment of choice.