Abstract
Background: Infants with congenital muscular torticollis are born with an asymmetric range of motion and a muscular imbalance in the cervical spine, as a result of a shortening or excessive contraction of the sternocleidomastoid muscle. Purpose: The study aimed to investigate passive range of motion (PROM) for rotation and lateral flexion, and muscle function of the cervical spine in children that had a history of CMT as infants. Study design: a prospective cohort study. Patient sample: 58 children at the age of 3.5 to 5 years that had been treated for CMT have infants participated in the study. Method: PROM was measured with protractors and muscle function was estimated with a modified Muscle Function Scale. Data from infancy were taken from earlier records. Result: PROM in rotation of the neck was mean 98.7° and PROM in lateral flexion of the neck was mean 69.1°. Symmetric PROM of the neck was found in 74% of the children for rotation and in 88% of the children for lateral flexion. Multiple regression showed that gender and PROM in rotation as infants had a significant impact on asymmetric PROM. Forty-five percent of the children had some degree of muscular imbalance in the lateral flexors of the neck. Conclusion: Possible risk factors for later asymmetric PROM are: gender, birth weight, gestation week and PROM in rotation as infants. These factors ought to be taken into consideration when developing guidelines for long-term follow-up.
Highlights
Congenital muscular torticollis (CMT) is a result of shortening or excessive contraction of the sternocleidomastoid muscle, often with limited Range of Motion (ROM) of the neck, in rotation on the affected side and in lateral flexion on the non-affected side
The mean, the standard deviation (SD) and the ranges were calculated for passive range of motion (PROM) in rotation and lateral flexion
Differences between children with asymmetric and symmetric PROM at their current age were assessed by analysis of covariance (ANCOVA), using the degree of asymmetric PROM as an infant, age at the start of treatment as an infant and current MFS scores, head tilt, plagiocephaly, age and gender as covariates
Summary
Congenital muscular torticollis (CMT) is a result of shortening or excessive contraction of the sternocleidomastoid muscle, often with limited Range of Motion (ROM) of the neck, in rotation on the affected side and in lateral flexion on the non-affected side. For infants/ children with CMT there is an imbalance in muscle function i.e. they have a lack of muscular strength and endurance around the neck on the non-affected side and sometimes an excessive muscular strength on the affected side [1,2]. The reference values for Passive ROM (PROM) in rotation of the neck for healthy children aged 3.5 to 5 years have been shown to be mean 100.1 ̊ (SD 7.7 ̊) [7] This is ten degrees less than for healthy infants with a mean of 110 ̊ (SD 6.2 ̊) [3]. PROM in lateral flexion of the neck for healthy children aged 3.5 to 5 year is mean 68.5 ̊ (SD 3.4); this is very close to the mean for healthy infants which is 70 ̊ (SD 2.2). The local ethical committee approved the study and the parents gave their informed consent
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