0
Articles   |    
Clinical Determinants of the Outcome of Manual Stretching in the Treatment of Congenital Muscular Torticollis in Infants A Prospective Study of Eight Hundred and Twenty-one Cases
J.C.Y. Cheng, MD; M.W.N. Wong, MBBS; S.P. Tang, MD; T.M.K. Chen, MPhil; S.L.F. Shum, RPT(HK); E.M.C. Wong, MA
View Disclosures and Other Information
Investigation performed at The Chinese University of Hong Kong and the Prince of Wales Hospital, Hong Kong, China
J.C.Y. Cheng, MD M.W.N. Wong, MBBS S.P. Tang, MD E.M.C. Wong, MA Department of Orthopaedics and Traumatology (J.C.Y.C., M.W.N.W., and S.P.T.) and the Centre for Clinical Trials and Epidemiological Research (E.M.C.W.), The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China. E-mail address for J.C.Y. Cheng: jackcheng@cuhk.edu.hk.
T.M.K. Chen, MPhil Department of Physiotherapy, Kowloon Hospital, Hong Kong SAR, China
S.L.F. Shum, RPT(HK) Department of Physiotherapy, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds have been received in support of this study.

J Bone Joint Surg Am, 2001 May 01;83(5):679-687
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: The natural history of congenital muscular torticollis and the outcome of different treatment modalities have been poorly investigated, and the results of treatment have varied considerably.

Methods: The main objective of this prospective study was to evaluate the outcomes of 821 consecutive patients with congenital muscular torticollis who were first seen when they were less than one year old, were treated with a standardized program of manual stretching, and were followed for a mean of 4.5 years. Before treatment, the patients were classified into one of three clinical groups: (1) palpable sternomastoid tumor, (2) muscular torticollis (thickening and tightness of the sternocleidomastoid muscle), and (3) postural torticollis (torticollis but no tightness or tumor).

Results: Of the 821 patients, 452 (55%) had a sternomastoid tumor; 276 (34%), muscular torticollis; and ninety-three (11%), postural torticollis. Multivariate analysis of the outcomes showed that (1) the duration of treatment was significantly associated with the clinical group (p < 0.0001), a passive rotation deficit of the neck (p < 0.0001), involvement of the right side (p < 0.0001), difficulties with the birth (p < 0.009), and age at presentation (p < 0.0001); (2) the overall final assessment score was associated with the rotation deficit (p = 0.02), age at presentation (p = 0.014), and duration of treatment (p < 0.0001); and (3) subsequent surgical treatment was required by 8% (thirty-four) of the 452 patients in the sternomastoid tumor group compared with 3% (eight) of the 276 patients in the muscular torticollis group and 0% (none) of the ninety-three patients in the postural torticollis group.

Conclusions: This large prospective study demonstrated that controlled manual stretching is safe and effective in the treatment of congenital muscular torticollis when a patient is seen before the age of one year. The most important factors that predict the outcome of manual stretching are the clinical group, the initial deficit in rotation of the neck, and the age of the patient at presentation. Surgical treatment is indicated when a patient has undergone at least six months of controlled manual stretching and has residual head tilt, deficits of passive rotation and lateral bending of the neck of >15°, a tight muscular band or tumor, and a poor outcome according to our special assessment chart.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    03/05/2014
    OK - The University of Oklahoma
    03/27/2014
    MA - Boston Medical Center and Boston University School of Medicine
    03/19/2014
    VA - VIRGINIA COMMONWEALTH UNIVERSITY MEDICAL CENTER