Congenital Muscular Torticollis

T/F: AA joint instability can be a mimicker in presentation for CMT?

TRUE

T/F: CMT is the 3rd most common congenital mskel diagnosis?

TRUE

T/F: a common driving factor for CMT is a compensation by the mskel system due to visual impairments?

TRUE

T/F: surgical indications for CMT include having a >15º limitation in C/S rotation and significant impairments past 1-year and failure of PT?

TRUE

• All of the following are associated conditions that can present with CMT except for? (can be more than one) (a) Plagiocephaly / Bradiocephaly (cranial deformities) (b) Hip dysplasia (c) CP (d) stroke (e) Brachial Plexus Injury (f) TMJ disorder (g) SCI (h) facial asymetry

c) CP (d) stroke (g) SCI

• Can you pick out all of the high-risk characteristics for CMT? (1) Birth trauma (2) Prima Para (1st born) (3) multiple births (4) forceps or vacuum delivery (5) baby's body length (6) Male gender (7) Facial Asymmetry (8) Plagiocephaly

(1) Birth trauma (2) Prima Para (1st born) (5) baby's body length (7) Facial Asymmetry (8) Plagiocephaly

• When doing a neuro screen for a ped pt with CMT, you need to assess what 2 things?

(1) Developmental delay --> other congenital conditions (2) Spasticity / abnormal tone --> CP / Muscular dystrophy

• No PROM restrictions of C/S motion with no SCM tightness and only postural preference for the baby to look that direction due to plagiocephaly --> accurately describes which classification of CMT?

(1) Postural

• Name the 3 classifications of CMT?

(1) Postural (2) Muscular (3) SCM mass

• Can you name the 2 greatest prognostic indicators for CMT?

(1) age in which the patient is dx (2) age in which the child began PT treatment

• SCM tightness with C/S PROM limitations without any palpable mass of the SCM --> accurately describes which classification of CMT?

(2) Muscular

• Palpable fibrotic mass of the SCM with PROM C/S limitations usually present at birth and will typically be reabsorbed by 4-months --> accurately describes which classification of CMT?

(3) SCM mass

• CMT is defined as? (select that description that is not true) (a) Defined for the side that is opposite of the tilt (b) non-progressive postural deformity that presents at birth or shortly after birth (c) characterized by the head tilt to one side with contralateral rotation due to SCM shortness/fibrosis

(a) Defined for the side that is opposite of the tilt --> (named for the side of the head tilt / the involved SCM)

• These 3 mskel red-flags indicate referral to an orthopedist? (choose the correct ones) (a) Extramuscular mass (b) Hip Dysplasia (c) Poor Visual Tracking (d) Abnormal mm tone (e) vertebral / spinal deformity

(a) Extramuscular mass (b) Hip Dysplasia (e) vertebral / spinal deformity

• These are 3 procedures that can be used for CMT? (a) tendon lengthening (b) unipolar release of distal SCM attachment (c) SPLATT (d) Tendoachille's lengthening (e) bipolar release of SCM

(a) tendon lengthening (b) unipolar release of distal SCM attachment (e) bipolar release of SCM

• All of the following are mskel conditions that need to be screened out except for? (a) Clavicle fracture (b) Scoliosis (c) rib fracture (d) Hip Dysplasia (e) chiari malformation (f) Brachial Plexus injury (g) Plagiocephaly (h) acoustic neuromsa

(c) rib fracture (e) chiari malformation (h) acoustic neuroma

• All of the following are appropriate PT interventions except for? (a) pt/caregiver education regarding home stretching (b) environmental adaptations (c) symmetrical movement development (d) Neck / Trunk strengthening (d) Neck PROM!!!!!!!!

(d) Neck / Trunk strengthening -->> stretching

• All of the following are true regarding the etiology of CMT except for? (a) In-Utero positioning (b) trauma/damage to the SCM during birth (c) Ischemic injury to SCM (d) brain aneurysm

(d) brain aneurysm --> All of the true options are "packaging problems"

T/F: your ped patient has a right CMT so then they would also have a right plagiocephaly?

FALSE --> Right CMT = Left Plagiocephaly (temporal/parietal flattening)

T/F: if a child is referred to PT by 3 months then there is only a 50% chance of a very positive outcome?

FALSE--> 99% of a favorable/positive outcome

T/F: your pt with CMT has neck folds, thus there is no chance of stagnant bacteria creating an infection of the integument?

FALSE--> check it for infection

T/F: always having your baby sleep on their back in the same position will NOT lead to plagiocephaly or CMT?

FALSE--> rotate their position 45º every time you put them in the crib

Anatomy Review: what are the actions of the SCM?

Ipsilateral C/S Flexion & Sidebend Contralateral C/S Rotation