A Clinical Comparative Study of Ultrasound-Normal Versus Ultrasound-Abnormal Congenital Muscular Torticollis

Abstract Objective To investigate the clinical features and outcome of outpatient-based physiotherapy (manual stretch) of congenital muscular torticollis (CMT) with passive neck motion limitation (≥10°) according to whether the finding on ultrasonography (US) is normal or abnormal. Design Case-contr...

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Published in:PM & R 2016-03, Vol.8 (3), p.214-220
Main Authors: Lee, Yong-Taek, MD, PhD, Park, Jong-Wan, MD, Lim, Mikyung, MS, PT, Yoon, Kyung Jae, MD, PhD, Kim, Yong Bum, MD, PhD, Chung, Pil-Wook, MD, PhD, Park, Hee-Jin, MD, PhD, Lee, So-Yeon, MD, PhD
Format: Article
Language:English
Subjects:
Exercise Therapy - methods
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Neck - diagnostic imaging
Physical Medicine and Rehabilitation
Physical Therapy Modalities
Retrospective Studies
Time Factors
Torticollis - congenital
Torticollis - diagnosis
Torticollis - rehabilitation
Treatment Outcome
Ultrasonography - methods
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Summary:Abstract Objective To investigate the clinical features and outcome of outpatient-based physiotherapy (manual stretch) of congenital muscular torticollis (CMT) with passive neck motion limitation (≥10°) according to whether the finding on ultrasonography (US) is normal or abnormal. Design Case-control study. Setting Institutional practice. Participants A total of 149 patients with CMT who met eligibility criteria were included: age at presentation ≤6 months, limitation of passive neck rotation (ΔROT) or lateral flexion (ΔLAT) ≥10°, and completion of our outpatient-based physiotherapy program. Interventions Patients were allocated to the US-normal or US-abnormal group. Patients underwent physiotherapy and were followed-up monthly until ΔROT and ΔLAT were ≤5° or did not respond to treatment. Main Outcome Measurements Baseline characteristics, initial ΔROT and ΔLAT, age at presentation, treatment durations, and success rates of physiotherapy were compared between 2 groups. Treatment duration was adjusted for initial ΔROT, ΔLAT, and age at presentation using analysis of covariance. Results Mean initial ΔROT and ΔLAT in US-abnormal (28.5°; 17.0°) were greater than in US-normal (7.9°, P < .001; 12.3°, P = .001, respectively). Mean age at presentation was older in US-normal (3.8 months) than in US-abnormal (1.8 months, P < .001). Treatment duration was shorter in the US-normal (5.1 weeks) than US-abnormal (14.9 weeks, P < .001). Adjusted treatment duration was also shorter in US-normal (9.7 weeks) than US-abnormal (13.8 weeks, P < .05). The success rates of physiotherapy were 95% in US-abnormal and 100% in US-normal. Two of 6 treatment failures in US-abnormal underwent surgery. Conclusions In CMT with passive neck motion limitation (≥10°), patients in the US-normal group demonstrated lesser passive neck motion limitation and older age at presentation than US-abnormal. It seems that US-normal showed shorter treatment duration irrespective of severity of neck motion limitation and age at presentation. Additionally, manual stretching applied before 6 months of age appears to show generally good outcome regardless of US findings.
ISSN:1934-1482
1934-1563
DOI:10.1016/j.pmrj.2015.07.014