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CONDITION/DISORDER SYNONYMS
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PREFERRED PRACTICE PATTERNS1
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4B: Impaired Posture
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation
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PATIENT PRESENTATION
A 6-month-old is referred to physical therapy with a diagnosis of torticollis. The mother reports she had too little maternal amniotic fluid during the pregnancy and premature rupture of the membranes 2 weeks before the baby was due but no other difficulties during delivery. She reports the infant was born with torticollis but that it is better than at birth. Upon examination, the therapist notes the baby postures into right lateral cervical flexion and left cervical rotation. There is a flattening of the occipital region on the right. The infant will only roll from prone to supine toward the left and supine to prone over the right arm. When placed in prone, the baby puts more weight on the right arm than the left in prone on elbows. When held in supported sitting or standing, the physical therapist notes asymmetry in postural alignment.
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Torticollis is a postural position of the neck with side-bending and opposite rotation.
Term used to describe asymmetrical posturing of neck due to shortened sternocleidomastoid.
Contracted state of the cervical muscles with sternocleidomastoid enlargement.
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Essentials of Diagnosis
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General Considerations
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Can have an etiology or can be idiopathic congenital muscular torticollis is the most common type2
Hip dysplasia in 20% of cases
At risk for scoliosis
Head tilted to one side and rotated to opposite side typically noted in first 6 to 8 weeks of life
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SIGNS AND SYMPTOMS
Asymmetrical cervical skin folds
Asymmetrical posturing of neck with lateral flexion on the affected side and rotation toward the unaffected side
Decreased passive and/or active range of motion
Enlargement of the neck muscles
Facial asymmetries
Flattened posterior skull
Pain
Palpable mass on sternocleidomastoid until 4 to 6 months of age
Possible difficulty swallowing5
Postural asymmetries
Shoulder elevation on affected side
Swelling of neck muscles at birth with congenital
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Functional Implications
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