Original Article
Clinical features and outcome of physiotherapy in early presenting congenital muscular torticollis with severe fibrosis on ultrasonography: a prospective study

https://doi.org/10.1016/j.jpedsurg.2011.02.040Get rights and content

Abstract

Background

It has been reported that ultrasonography (US) can detect the severity of congenital muscular torticollis (CMT), and severe fibrosis of the sternocleidomastoid (SCM) muscle noted on US is irreversible and likely to require surgery. Clinical outcome of CMT depends mainly on the patient's age, which is also associated with the severity of fibrosis as determined by US. However, there has been no well-designed study to elucidate the true relationship among these factors nor a definite consensus on treatment of young infants with severe fibrosis in the SCM compared with well-documented reports that late cases require surgery.

Purpose

The purpose of the current study was to investigate whether severity of SCM fibrosis on US is correlated with clinical severity and outcome of standardized physiotherapy in early presenting CMT.

Methods

Fifty patients with a palpable neck mass, initial deficit of passive neck rotation (ΔROT) more than 10°, and age less than 3 months were classified into 4 US types according to the severity of fibrosis in the SCM and underwent standardized physiotherapy and regular assessment. Relationship between US types and 2 variables (ΔROT and treatment duration) and success rate of physiotherapy was assessed.

Results

None of the cases was classified as type 4. Type 3 showed greatest ΔROT and longest mean treatment duration. Both variables showed a significant linear trend of association with US types by P for trend (P = .003, P < .001, respectively). Treatment was “successful” in 49 patients (98%).

Conclusion

In young infants with CMT, US can document severity; and an early and adequate physiotherapy is a good treatment option, particularly even in those with severe fibrosis.

Section snippets

Materials and methods

All infants with clinically suspected CMT were seen at the torticollis clinics of Kangbuk Samsung Hospital and Cheil General Hospital & Women's Health Care Center from 2008 to 2009. Fifty (32 boys, 18 girls) infants met the inclusion criteria, and the parents agreed to a conservative treatment program. The study protocol was approved by the institutional review boards of the Kangbuk Samsung Hospital. The present study was conducted in accordance with the Declaration of Helsinki. All patients

Results

Fifty infants (32 boys, 18 girls) whose ages ranged from 20 days to 3 months (1.51 ± 0.72 months) were included in this study. Among the 50 patients, 25 (50.0%) had type 1, 8 (16.0%) had type 2, and 17 (34.0%) had type 3 fibrosis. None of the subjects was classified as type 4. Basic clinical characteristics, including mean age at presentation, thickness ratio, birth weight, and affected side, were statistically similar among the different US types (Table 1). Initial ΔROT of type 3 patients was

Discussion

Initial ΔROT was greater in cases with severe fibrosis on US than in other milder types. The mean duration of treatment as the clinical outcome parameter was longer in the severe type than other milder type. These 2 variables showed a statistically significant linear trend of association and correlation with severity of fibrosis on US. These findings were consistent with previous reports that showed that the severity of restriction of neck rotation at the beginning of treatment was a predictor

References (27)

  • J. Gonzales

    Congenital torticollis: evaluation by fine-needle aspiration biopsy

    Laryngoscope

    (1989)
  • J.C. Cheng

    Outcome of surgical treatment of congenital muscular torticollis

    Clin Orthop

    (1999)
  • Y.L. Chan et al.

    Ultrasonography of congenital muscular torticollis

    Pediatr Radiol

    (1992)
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