Öhman A. Congenital muscular torticollis. Licentiatavhandling 2007.
Congenital Muscular torticollis
Anna Öhman. Institute of Neuroscience and Physiology, Division of Physical Therapy, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
Aim: The aim of study I was to describe the functional and cosmetic status in children earlier treated for congenital muscular torticollis (CMT) with regard to asymmetry of head position, range of motion (ROM), muscle function i.e. strength/endurance and craniofacial asymmetry. The aim of study II was to find reference values for ROM in rotation and lateral flexion in the paediatric cervical spine and also to find reference values muscle function in the lateral neck flexorers of infants.
Methods: Fifty-four children treated for CMT between the years 1999 and 2001 at the Department of Physiotherapy at Queen Silvia Children’s Hospital, Göteborg, Sweden participated in study I. In study II 38 healthy infants participated, they were recruited between October 2004 and October 2005 from the Child Health Centre in Göteborg, Sweden. In both studies ROM in rotation and lateral flexion of the neck were measured and muscle function i.e. strength/endurance of the lateral flexor muscles of the neck were estimated. Neck rotation was measured with an arthrodial protractor. Lateral flexion was measured with the infant/child lying in supine on a big protractor. Muscle function i.e. strength/endurance of the lateral flexor muscles of the neck was measured in study I with the child lying on the side lifting their head up. In study II muscle function of the neck lateral flexor muscles was estimated with a five-degree scale. Also the presence of asymmetry of the face, posture and lateral band were observed and estimated according to a scoring sheet in study I. The parents answered a questionnaire about birth history and completed a subjective assessment.
Results: In study I the majority of the children attained an overall excellent/good status and the most notable findings were craniofacial asymmetry and asymmetry in muscle function i.e. strength/endurance. There were moderate correlations between craniofacial asymmetry and rotation (p=0.00, r=0,39), between rotation and side flexion (p=0,00 r=0.47) and a strong correlation between head tilt and subjective assessment (p=0.00 r=0,62). The overall score had a moderate correlation with both craniofacial asymmetry and rotation and a strong correlation with head tilt. In study II reference values for the mean ROM in neck rotation in healthy infants were in mean 110° with SD 6,2° and a range between 100°-120°. The measurements in rotation at two months of age were about 5° less than at the other ages. In lateral flexion the mean ROM was 70° with SD 2,2° and a range between 65°-75°. Infants of two months of age had the median muscle function score of 1 interquartile range 1 to 2. Infants of four months of age had the median score 3 interquartile range 2 to 3. Infants of six months of age had the median score of 3 and interquartile range 3. Infants of ten months of age had the median score 3 interquartile range 3 to 4. There was no significant difference between genders.
Conclusion: In study I most children had an overall excellent/good status and the most notable findings were craniofacial asymmetry and asymmetry in muscle endurance. Functional problems were rare. More studies are needed to find out the importance of muscular balance between the affected and non- affected side and also suitable treatment and duration of treatment. In study II reference values for ROM in infants in rotation of the neck were 110° with a range 100°-120° and in lateral flexion 70° with a range 65°-75°. In muscle function most two months old infants scored 1 and the scores increased with age. Reference values for muscle function in the neck can be used in clinic to grade muscle function in infants with CMT.
Keywords: Craniofacial asymmetry, rotation, lateral flexion, muscle function, infants, reference values, torticollis, physiotherapy.