Congenital Muscular Torticollis In Infants Research Articles

Bilateral congenital muscular torticollis in infants, report of two cases

Background Congenital muscular torticollis (CMT) is a well-known diagnosis among physiotherapists specializing in pediatric care, especially when working with infants. However, knowledge of bilateral torticollis is limited. The purpose of this article was to describe how bilateral torticollis can appear in infants. Case One infant with CMT with sternocleidomastoid tumor (SMT) on the right side, and some limitation in rotation towards the right side and in lateral flexion towards the left side, that is, the muscle on the right side was shortened. While sitting with support, he tilted the head to the left and was stronger in the lateral flexors on the left side which fit well with a postural left-sided torticollis (PT). The other infant had bilateral muscular torticollis (MT), the sternocleidomastoid muscle thickened bilaterally, and both active and passive rotations were affected. The head was held in flexion, and active rotation was severely limited to both sides. For both cases the therapeutic interventions were to gain a normal range of motion (ROM) and a good posture of the head. Conclusions CMT can appear in different ways and may be bilateral. Both infants gained good ROM and better head position, however case I still needs some training. To gain more knowledge about bilateral CMT, we should follow these cases over a longer period of time. It is important to communicate and discuss our experiences with each other to understand rare cases of CMT.

Chinese massage (Tuina) combline with paraffin therapy versus tuina or paraffin therapy alone for the treatment of congenital muscular torticollis: A protocol for systematic review and Bayesian network meta-analysis.

Background:Current studies in patients with congenital muscular torticollis (CMT) have predominantly focused on the role of tuina or paraffin therapy alone. This systematic review with Bayesian network meta-analysis will be performed to sum up the existing evidence on the effects and safety of tuina plus paraffin therapy for CMT in infants and children.Methods:The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes reporting guidelines will be followed to conduct this study. The electronic databases of PubMed, Cochrane Library, PsycINFO, EMBASE, the Chinese Scientific Journal Database, China National Knowledge Infrastructure, WanFang Data, Taiwan Electronic Periodical Services, and Web of Science will be searched from the inception to November 2021 using the following key terms: “Tuina,” “traditional Chinese medicine massage,” “paraffin,” and “congenital muscular torticollis,” for all relevant studies. We impose no language restrictions. We include reports on randomized controlled trials (RCTs) and quasi-RCTs of Tuina combline with paraffin therapy for the treatment of CMT in children and adolescents. We include studies that assessed effective rate, symmetry, improvements of range of motion, muscle length, and sternocleidomastoid tumor thickness, quality of life, and adverse events. The Cochrane Bias Risk Tool, which considers sequence generation, allocation concealment, and blinding and other aspects of bias, will be used to assess the risk of bias in studies.Results:A Bayesian network meta-analysis is an appropriate statistical method to compare all treatment options by statistically simulating the estimated results of a comprehensive trial, and to compare treatments by common and associated comparators. In addition, Bayesian network meta-analysis can produce ranking probabilities of treatments, which may contribute to clinicians’ clinical decision-making.Registration number:10.17605/OSF.IO/K5EGN.

Correlations between the Clinical and Ultrasonographic Parameters of Congenital Muscular Torticollis without a Sternocleidomastoid Mass.

ObjectiveTo determine whether ultrasonography at initial presentation can help assess the clinical severity of congenital muscular torticollis (CMT) in infants without a sternocleidomastoid muscle (SCM) mass.Materials and MethodsThis retrospective study included 71 infants aged less than 12 months (4.1 ± 2.3 months) with non-mass CMT. The clinical severity was divided into three grades (groups 1–3) based on the degree of lateral head bending or cervical rotation. The difference (SCM-D) and ratio (SCM-R) between the maximal thickness of the affected and non-affected SCMs were obtained using transverse and longitudinal ultrasonography. The sonographic echotexture and echogenicity of the involved SCM were reviewed.ResultsA significant difference was observed in the SCM-D (0.42 ± 0.30 mm in group 1; 0.74 ± 0.50 mm in group 2; 1.14 ± 0.85 mm in group 3; p = 0.002) and SCM-R (1.069 ± 0.067 in group 1; 1.129 ± 0.087 in group 2; 1.204 ± 0.150 in group 3; p = 0.001) among the groups when measured along the longitudinal but not along the transverse ultrasonography plane. The areas under the curves of the SCM-R and SCM-D measured by longitudinal ultrasonography were 0.731 (p < 0.001) and 0.731 (p < 0.001) for group 1 versus groups 2–3. The proportions of heterogeneous echotexture or hyperechogenicity in the involved SCM did not differ significantly among the three clinical groups (all p > 0.05).ConclusionUltrasonography can aid in assessing the clinical severity of CMT in infants without an SCM mass at the time of initial diagnosis. The SCM-R and SCM-D helped grade the clinical severity when obtained by longitudinal scan.

Applied research of ultrasound real-time elastography in early diagnosis of congenital muscular torticollis in infants

Objective To discuss the applied value of ultrasound real-time elastography (RTE) in early diagnosis of congenital muscular torticollis (CMT) in infants. Methods Three hundred and thirty-six infants with CMT under 3-year-old were received the conventional ultrasound and RTE examination on their diseased sternocleidomastoid (SCM). And then a retrospective analysis was carried out by comparing the examination result with clinical observation and surgical pathology. Results The ultrasound performance of these 336 infants were divided into mass type (251 cases, 75%), and diffuse type (85 cases, 25%). RTE score for healthy side was grade Ⅰ; RTE scores for unhealthy side was grade Ⅱ in 97 cases, grade Ⅲ in 186 cases, and grade Ⅳ in 53 cases, respectively. Strain ration (SR) for mass type was 0.76-4.42, and for diffuse type was 1.49-7.07. By regarding pathological result as the standard, ROC curve was constructed to determine the best operation opportunity guided by ultrasound, SR 3.35 was a critical point of operative and nonoperative treatment (sensitivity 87.7%, specificity 98.2%, accuracy 96.1%). By using RTE dynamic observation, 272 cases (81%) with low RTE scoring of CMT got the effect by non-operative treatment and 64 cases (19%) with high RTE scoring of CMT were cured by operative treatment. Conclusions RTE can provide more objective semi-quantitative data about stiffness for SCM disease and it′s helpful for making resonable clinical treatment plans and dynamically observing its efficacy. Key words: Elasticity imaging techniques; Infant; Torticollis

선천성 근성 사경 환아의 흉쇄유돌근 초음파 소견과 사경종합평가 사이의 상관관계

본 연구의 목적은 사경의 진단 및 평가에 많이 사용되고 있는 초음파 검사와 이학적 검사 도구인 사경종합평가의 상관성 검증을 통해 사경종합평가의 유용성을 알아보는 것이다. 선천성 근성 사경으로 진단 받은 환아 78명을 연구 대상으로 하였다. 사경 환아를 초음파 소견을 통한 흉쇄유돌근(목빗근) 섬유화 정도에 따라 네 유형으로 분류하였고, 사경종합평가를 통한 장애 정도에 따라 세 가지 유형으로 분류하였다. 초음파 영상 소견을 통해 분류된 환아 중 제1유형이 42명(53.8%); 제2유형이 21명(26.9%); 제3유형이 7명(9.0%); 제4유형이 8명(10.3%)이었다. 발현 연령은 초음파 제1유형에서 2.3<TEX>${\pm}$</TEX>0.8개월로 다른 유형에 비해 유의하게 빨랐으며(p<0.01), 제4유형에서 20.2<TEX>${\pm}$</TEX>12.1개월로 가장 늦었다(p<0.01). 유형별로 분류된 초음파 검사와 사경종합평가의 상관관계에서 파이상관계수는 <TEX>${\phi}$</TEX>=0.893으로 통계적으로 유의한 높은 상관관계를 보였다(p<0.01). 본 연구의 결과, 간단하며 객관적 검사 도구인 사경종합평가는 사경을 치료하는 물리치료사가 쉽게 적용할 수 있어 임상에서 폭넓게 활용될 수 있을 것으로 기대한다. The purpose of this study was to investigate the correlation between ultrasonographic findings used to diagnose and assess of torticollis and a overall special assessment of congenital muscular torticollis in infants. Seventy-eight subjects with congenital muscular torticollis participated in this study. All the patients were divided into one of four clinical types according to the sternocleidomastoid muscle fibrosis noted on the ultrasonographic findings, and they were divided into one of three subgroups according to the degree of disability on the overall special assessment score of torticollis. For the ultrasonographic classifications of the 78 patients, 42(53.8%) made up the first type, 21 (26.9%) made up the second type, 7 (9.0%) made up the third type, and 8 (10.3%) made up the fourth type. Multivariate analysis of the results showed that the age at presentation was significantly different according to the ultrasonographic subtypes (p<0.01). There was significant correlation between the ultrasonographic findings and the torticollis overall assessment for patients with congenital muscular torticollis (<TEX>${\phi}$</TEX>=0.893, p<0.01). According to the results of this study, the use of the simple and objective torticollis overall assessment will be useful for the evaluation of torticollis in the future.

Congenital Muscular Torticollis in Infants: Ultrasound-Assisted Diagnosis and Evaluation

Congenital Muscular Torticollis in Infants: Ultrasound-Assisted Diagnosis and Evaluation

Congenital Muscular Torticollis in Infants: Ultrasound-Assisted Diagnosis and Evaluation

Ultrasonography is considered the modality of choice for differentiating congenital muscular torticollis from other pathologies in the neck. The authors present their experience with ultrasound examination for the evaluation and management of congenital muscular torticollis. Twenty-six infants, 14 boys and 12 girls, age ranging from 1 to 16 weeks, with torticollis and a palpable mass were examined. Ultrasound showed a well-defined mass in the sternocleidomastoid muscle. The lesions ranged in size from 8 to 15.8 mm on maximal transverse diameter, with length ranging from 13.7 to 45.8 mm. Clinically the torticollis disappeared between 1 to 6 weeks, with complete clinical reduction of the palpated mass between 2 and 8.5 weeks. The ultrasonographic disappearance of the mass was delayed by an average of 2 weeks in comparison to the clinical disappearance of the mass. Ultrasound is advocated for the diagnosis and follow-up of congenital muscular torticollis because it noninvasively provides reliable and dynamic information without sedation.

Identification and Treatment of Congenital Muscular Torticollis in Infants

Identification and Treatment of Congenital Muscular Torticollis in Infants

Long-term experience with endoscopic surgical treatment for congenital muscular torticollis in infants and children: a review of 85 cases.

Long-term experience with endoscopic surgical treatment for congenital muscular torticollis in infants and children: a review of 85 cases.

Snapping During Manual Stretching in Congenital Muscular Torticollis

Manual stretching frequently is used in the treatment of congenital muscular torticollis in infants. During manipulation, it is not uncommon for the sternocleidomastoid muscle to snap or suddenly give way. The main objective of this study was to evaluate the predisposing causes and clinical significance of such snapping. Four hundred fifty-five patients younger than 1 year of age with congenital muscular torticollis treated with a standardized gentle manual stretching program during a 13-year period were studied. Using prospective standardized assessment parameters, the pretreatment, treatment, and followup results of a group of 41 patients with snapping detected during treatment were compared with the results of a group of 404 patients without snapping during treatment. The group with snapping was associated with a more severe sternomastoid tumor, higher incidence of hip dysplasia, earlier clinical presentation, and shorter duration of treatment. With a mean followup of 3.5 years, the group with snapping was not different from the group that had no snapping in the final assessment score and percentage requiring surgery. From this study, unintentional snapping during the gentle manipulation treatment of congenital muscular torticollis has clinical and ultrasonographic evidence of partial or complete rupture of the sternocleidomastoid muscle. No long-term deleterious effect on the outcome was observed after the snapping.

The clinical presentation and outcome of treatment of congenital muscular torticollis in infants—A study of 1,086 cases

Background/Purpose: The main objectives of this study were to define the clinical patterns and characteristics of congenital muscular torticollis (CMT) presented in the first year of life and to study the outcome of different treatment methods. Methods: This is a prospective study of all CMT patients seen in 1 center over a 12-year period with uniform recording system, assessment methods, and treatment protocol. Results: From a total of 1,086 CMT infants, 3 clinical subgroups of sternomastoid tumor (SMT; 42.7%), muscular torticollis (MT; 30.6%), and postural torticollis (POST; 22.1%) were identified. The SMT group was found to present earlier within the first 3 months and was associated with higher incidence of breech presentation (19.5%), difficult labor (56%), and hip dysplasia (6.81%). Severity of limitation of passive neck rotation range (ROTGp) was found to correlate significantly with the presence of SMT, bigger tumor size, hip dysplasia, degree of head tilt, and craniofacial asymmetry. Conclusions: A total of 24.5% of the patients with initial deficits of passive rotation of less than 10° showed excellent and good outcome with active home positioning and stimulation program. The remaining cases with rotation deficits of over 10° and treated with manual stretching program showed an overall excellent to good results in 91.1% with 5.1% requiring subsequent surgical treatment. The most important prognostic factors for the necessity of surgical treatment were the clinical subgroup, the ROTGp, and the age at presentation (P <.001). J Pediatr Surg 35:1091-1096. Copyright © 2000 by W.B. Saunders Company.

Sternocleidomastoid pseudotumor and congenital muscular torticollis in infants: A prospective study of 510 cases

Objectives: Congenital muscular torticollis is a common and controversial condition in infancy. We studied prospectively a group of infants with clearly defined sternomastoid tumor treated with a well-defined protocol. Study design: A total of 510 cases of sternomastoid tumor in infants over a 10-year period were studied prospectively with a mean follow-up of 3.5 years and a range from 1.5 years to 13 years. The clinical presentations, associated abnormalities, treatments, and outcomes of the overall group and subgroups were evaluated to determine the most important prognostic factors. Results: The mean age of presentation was day 24, with most (92.7%) presenting before the age of 3 months. There was a high correlation with breech presentation and assisted delivery. Clinical subgroups according to the deficit in passive rotation of the neck correlated with the incidence of hip dysplasia (up to 11.6%), mode of delivery, time of presentation, degree of craniofacial asymmetry, head tilt, and the size and extent of the pseudotumor ( P < .05). With an early and prolonged manual stretching program, 90.7% had excellent and good overall results. The 6.7% of patients in the poor outcome group requiring surgical treatment all belonged to the more severe rotation limitation groups. Conclusions: Subgrouping patients with sternomastoid tumor according to the passive limitation of rotation of the neck has prognostic significance, with good overall results of conservative treatment with manual stretching. (J Pediatr 1999;134:712-6)