What are the guideline sources, guidelines and references for Congenital muscular torticollis ?
Guideline sources The following summarized guidelines for the evaluation and management of congenital muscular torticollis are prepared by our editorial team based on guidelines from the American Physical Therapy Association (APTA 2013). 1 2 2 2 3 Definition Congenital muscular torticollis is a benign congenital musculoskeletal disorder characterized by unilateral shortening of the sternocleidomastoid muscle that leads to ipsilateral head tilt and contralateral rotation of the face and chin. 2 Epidemiology The exact cause of congenital muscular torticollis is still unknown; however, several theories have been proposed including intrauterine crowding, muscle trauma during a difficult delivery, soft tissue compression leading to compartment syndrome, and congenital abnormalities of soft tissue differentiation within the sternocleidomastoid muscle. 2 Disease course Clinical manifestations include ipsilateral head tilt and contralateral rotation of the face and chin, plagiocephaly, palpable pseudotumor, and tightness of the muscle. Untreated congenital muscular https://web.pathway.md/diseases/recuyvwMlqWOQr1sz 1/4 6/23/23, 3:35 AM Congenital muscular torticollis Pathway torticollis in infancy may lead to craniofacial growth deformity in adults. 2 Prognosis and risk of recurrence Congenital muscular torticollis is not associated with increased mortality. 3 Guidelines 1. Screening and diagnosis Differential diagnosis: perform a screening examination of the neurological, musculoskeletal, integumentary, and cardiopulmonary systems (including evaluation of positional preference, structural integrity of the musculoskeletal system and movement symmetry) when a clinician, parent, or caretaker indicates concern about head or neck posture and/or developmental progression. B 2. Classification and risk stratification Severity classification: grade the severity of congenital muscular torticollis according to a 7-grade rating scale. B 3. Diagnostic investigations Physical examination: assess for the presence of neck and/or facial or cranial asymmetry within the first 2 days of birth, using passive cervical rotation, passive lateral flexion, and/or visual observation. A Clinical history: Obtain a general medical and developmental history, including the following specific factors: age at initial visit age of symptom onset pregnancy history delivery history including birth presentation and use of assistance head posture/preference family history of congenital muscular torticollis other known or suspected medical conditions developmental milestones. B 4. Nonpharmacologic interventions https://web.pathway.md/diseases/recuyvwMlqWOQr1sz 2/4 6/23/23, 3:35 AM Congenital muscular torticollis Pathway Physical therapy interventions: Address at least these 5 components in the physical therapy plan of care for the infant with congenital muscular torticollis or postural asymmetry: neck passive ROM neck and trunk active ROM development of symmetrical movement environmental adaptations parent/caregiver education. B 5. Patient education General counseling: determine the prognosis for resolution of congenital muscular torticollis and the episode of care after completion of the evaluation, and communicate it to the parents/caregivers. B Documentation: Discharge infants diagnosed with congenital muscular torticollis or asymmetrical posture from physical therapy services when the infant meets the following criteria: full passive ROM within 5 degree of the nonaffected side symmetrical active movement patterns throughout the passive range age-appropriate motor development and no visible head tilt appropriate parents/caregiver understanding as to what to monitor as the child grows. B 6. Follow-up and surveillance Indications for specialist referral: refer infants identified as having positional preference, reduced cervical ROM, sternocleidomastoid masses, facial asymmetry and/or plagiocephaly to the primary pediatrician and a physical therapist as soon as the asymmetry is noted. B Serial clinical assessment: perform a systematic examination (including positional preference, structural and movement symmetry of the neck, face and head, trunk, hips, upper and lower extremities, and assessment of developmental milestones) 3 to 12 months following discharge from physical therapy intervention, or when the child initiates walking. B References 1. Kaplan SL, Coulter C, Fetters L. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatr Phys Ther. 2013 Winter;25 4 348 94. Open 2. Kumar Nilesh, Srijon Mukherji. Congenital muscular torticollis. 2013 Jul;3 2 198 200.2013 Jul;3 2 198 200. Open 3. Barbara Sargent, Sandra L Kaplan, Colleen Coulter et al. Congenital Muscular Torticollis: Bridging the Gap Between Research and Clinical Practice. 2019 Aug;144 2):e20190582.2019 Aug;144 2):e20190582. https://web.pathway.md/diseases/recuyvwMlqWOQr1sz 3/4 6/23/23, 3:35 AM Congenital muscular torticollis Pathway Open 4. Kumar Nilesh and Srijon Mukherji. Congenital muscular torticollis. Ann Maxillofac Surg. 2013 Jul-Dec; 3 2 198 200. Open 5. N. Hardgrib, O. Rahbek, B. M ller-Madsen et al. Do obstetric risk factors truly influence the etiopathogenesis of congenital muscular torticollis?. J Orthop Traumatol. 2017 Dec; 18 4 359 364. Open 6. Barbara Sargent, Sandra L. Kaplan, Colleen Coulter et al. Congenital Muscular Torticollis: Bridging the Gap Between Research and Clinical Practice. Pediatrics. 2019 Aug; 144 2 e20190582. Open https://web.pathway.md/diseases/recuyvwMlqWOQr1sz 4/4