Surgical treatment of congenital muscular torticollis. When to refer to surgery?

Scientific article in Fysioterapeuten 6/2015.

Abstract

Anja Medbø, spesialfysioterapeut, Oslo Universitetssykehus. amedboe@gmail.com.

Anita Hoddevik Dagsgard, Spesialist i barne- og ungdomsfysioterapi (MNFF), Oslo Universitetssykehus. andags@ous-hf.no.

Per Reidar Høiness, overlege, Dr.Med., Oslo Universitetssykehus.

Abstract

Aim: The aim of the study was to evaluate our results of treatment and to improve treatment and referral practices regarding congenital muscular torticollis (CMT) among physiotherapists.

Design: Children operated for congenital muscular torticollis (CMT) were clinically reviewed to evaluate satisfaction, function, cosmetics and quality of life..

Methods: 16 operated children were included from a cohort of 24 and examined in average 4 years postoperatively. Active and passive range of motion, strength and endurance was measured by two physiotherapists. Cheng score was used to rate functional and cosmetic parameters, and the Pediatric Quality of Life Initiative (PedsQL) was used to assess quality of life.

Results: Fourteen of 16 patients were satisfied and perceived a high quality of life. Neck movement and muscle strength was close to normal at the follow-up. Fifteen of 16 patients still had some facial asymmetry. The results were independent of age. Our results are consistent with other studies.

Conclusions: Current guidelines recommend early surgery. To counteract persistent malposition and facial asymmetry, psychological distress and unnecessary use of time and resources, these children should be referred to surgery when conservative treatment is unsuccessful within the first year of life.

Keywords: Congenital Muscular Torticollis, surgery, physical therapy.