Correlation of clinical and ultrasonographic features in congenital muscular torticollis

doi:10.1016/S0003-9993(99)90165-X

Archives of Physical Medicine and Rehabilitation

Volume 80, Issue 6, June 1999, Pages 637-641

https://doi.org/10.1016/S0003-9993(99)90165-X Get rights and content

Abstract

Objective: To find the relationship between the ultrasonographic pictures and the clinical features of patients with congenital muscular torticollis (CMT).

Design: Prospective survey of patients with clinically suspected CMT by high-resolution ultrasonography.

Setting: Rehabilitation department of a tertiary care center.

Participants: Two hundred fifty-six CMT patients, from the ages of 9 days to 16yrs, with a mean follow-up period of 6.7 months.

Main Outcome Measures: Correlation of the ultrasound appearance of the involved sternocleidomastoid (SCM) muscles with clinical features. The pathologic findings in diseased muscles from patients who underwent surgical intervention were also evaluated.

Results: Muscle abnormalities were identified ultrasonographically in 218 CMT patients (85%) and were classified into four types: a fibrotic mass in the involved muscle (type I, 15%); diffuse fibrosis mixing with normal muscle (type II, 77%) and without normal muscle in the involved muscle (type III, 5%); and a fibrotic cord in the involved muscle (type IV, 3%). Compared with type I patients, type IV patients were more likely to undergo surgical treatment (odds ratio = 31.54, p = .0196). Type III patients were more likely to undergo surgical treatment, although this tendency was not statistically significant.

Conclusion: Ultrasonography can precisely identify pathologic changes in the involved SCM muscle of CMT patients. Type III and IV patients are more likely to require surgical intervention.

References (23)

JN Lin et al.
Ultrasonographic study of the sternocleidomastoid muscle in the management of congenital muscular torticollis
J Pediatr Surg
(1997)
CM Ling et al.
Sternomastoid tumor and muscular torticollis
Clin Orthop Rel Res
(1972)
G Hong et al.
Congenital torticollis-a review and result study
Surg Gynecol Obstet
(1934)
JCY Cheng et al.
Infantile torticollis: a review of 624 cases
J Pediatr Orthop
(1994)
SB Porter et al.
Pseudotumor of infancy and congenital muscular torticollis
Am Fam Physician
(1995)
J Gonzales et al.
Congenital torticollis: evaluation by fine-needle aspiration biopsy
Laryngoscope
(1989)
JR Sty et al.
Congenital muscular torticollis: computed tornographic observation
Am J Dis Child
(1987)
RB Whyteam Lufkin et al.
Sternocleidomastoid fibrosis in congenital muscular torticollis: MR appearance
J Comput Assist Tomogr
(1989)
JR Davids et al.
Congenital muscular torticolli: Sequela of intrauterine or perinatal compartment syndrome
J Pediatr Orthop
(1993)
S Sipilä et al.
Muscle ultrasonography and computed tomography in elderly trained and untrained women
Muscle Nerve
(1993)

M van Holsbeeck et al.

Musculoskeletal ultrasonography

Radiol Clin North Am

(1992)

Cited by (44)

Relationship between sonography of sternocleidomastoid muscle and cervical passive range of motion in infants with congenital muscular torticollis
2018, Biomedical Journal
An abnormal sternocleidomastoid muscle in congenital muscular torticollis can be classified into one of the four types via sonography. However, this categorization lacks quantitative measurements. The purpose of the study was to determine quantitative measurements of the sonograms via image analysis.
Infants younger than 12 months of age suspected of having congenital muscular torticollis were included. Intraclass correlation coefficient estimates for interobserver reliability and a simple regression analysis for criterion validity were calculated. Spearman correlation analysis was then performed. The analyzed parameters included cervical passive range of motion for lateral flexion and rotation, area, brightness, max/min Feret's diameters, and muscular width/thickness.
Of the 29 (4.0 ± 2.6 months) screened infants, 13 (1.9 ± 1.7 months) were included. Nine were male, and 4 were female. Seven infants with mass were ultrasonographically classified into type I, and the other six infants were classified into type II. The affected/unaffected side ratios of cervical passive range of motion for lateral flexion and rotation were 0.92 ± 0.13 and 0.88 ± 0.16, respectively. The parameters measured on the sonograms were reliable, and the max/min Feret's diameters were valid measurements. The affected/unaffected side ratio of cervical passive range of motion for rotation significantly correlated with the affected/unaffected side ratios of the sternocleidomastoid muscle sonogram on area (r = −0.62, p = 0.03) and min Feret's diameter (r = −0.69, p = 0.01).
The area and min Feret's diameter were efficacious parameters for image analysis on sternocleidomastoid sonograms, and the min Feret's diameter would be more suitable than thickness for measuring the thickening SCM in transverse view. A healthy control group, more data and follow-up would be needed to confirm the changes on the SCM sonograms for clinical decision.
Rehabilitative ultrasound imaging in musculoskeletal and neuromuscular disorders
2017, Kinesitherapie
L’examen clinique et l’imagerie médicale sont des outils précieux pour le kinésithérapeute dans les champs musculo-squelettique et neuro-musculaire. Cependant, l’utilisation de ces outils présente de nombreuses limites en termes de précision diagnostique. L’échographie musculo-squelettique et neuro-musculaire permet une meilleure qualité d’image pour l’observation de nombreuses structures anatomiques (tendon, ligament, capsule, muscle, etc.) comparativement aux autres techniques d’imagerie. Son faible coût, son absence d’effets secondaires, le grand nombre d’articulations observables, son caractère non invasif et la possibilité d’analyser les structures en temps réel sont autant d’atouts à une utilisation systématique dans le cadre des déficits de structure et de fonction du membre supérieur, du membre inférieur, du tronc et du bassin. Dans le cadre de la prescription médicale, cet outil permet au kinésithérapeute de participer à la confirmation ou à l’infirmation d’une hypothèse clinique à la suite de l’évaluation initiale afin de mieux orienter les stratégies thérapeutiques et leur réévaluation. Il peut également être utilisé comme outil de biofeedback pour faciliter l’apprentissage de la contraction musculaire du patient lors de la réalisation d’exercices rééducatifs. Cette revue narrative traite de l’utilisation de l’échographie musculo-squelettique et neuro-musculaire en kinésithérapie. Elle aborde l’évaluation échographique et son intérêt dans la décision clinique du kinésithérapeute. La revue explore la littérature et l’expérience clinique des auteurs sur l’utilisation de l’échographie musculo-squelettique et neuro-musculaire. Les illustrations proviennent de la pratique quotidienne de l’échographie musculo-squelettique des auteurs. L’échographie est un outil permettant aux kinésithérapeutes d’évaluer le potentiel de mouvement d’un patient. Il permet ainsi de faciliter la planification de programmes thérapeutiques de la dysfonction des mouvements altérés. Elle permet d’évaluer objectivement des structures lors de l’examen clinique pour confirmer ou infirmer les résultats des tests cliniques habituels. La modification des signes échographiques permet d’évaluer l’efficacité de la kinésithérapie en vue d’assurer un plan de traitement le mieux adapté possible au patient et à sa guérison. L’échographie musculo-squelettique, associée aux tests cliniques, améliore le choix des stratégies thérapeutiques à la suite de l’évaluation initiale et contribue à garantir une pertinence du traitement rééducatif lors du suivi du patient. Toutefois, l’utilisation de l’échographie nécessite la compréhension des principes et limites de cet outil, de solides connaissances en physiopathologie ainsi qu’une utilisation réfléchie fondée sur des méthodes validés et fiables. Tout ceci permet l’analyse statique et dynamique des structures anatomiques en lien avec l’évaluation clinique habituellement pratiquée lors du bilan-diagnostic kinésithérapique. Dans une optique de pratiques financièrement responsables et fondées sur des preuves, les kinésithérapeutes cherchent à optimiser l’efficacité de leurs interventions.
Non adapté.
Clinical examination and medical imaging are valuable tools for the physiotherapist in the musculoskeletal and neuromuscular field. However, these tools have many limitations in terms of diagnostic sensitivity and specificity. Ultrasound neuromuscular and musculoskeletal imaging provides better picture quality than other imaging techniques for many anatomical structures (tendon, ligament, capsule, muscle, etc.). Its low cost and lack of side effects, the large number of observable joints, its non-invasive nature and the possibility it offers of real-time analysis are all arguments in favour of its systematic use in structural and functional deficits of the upper limb, lower limb, trunk and pelvis. In the context of medical prescription, it allows the physiotherapist to contribute to the confirmation or invalidation of clinical hypotheses after initial assessment, to better guide therapeutic strategies and reassessment. It can also serve as a biofeedback tool, helping the patient to understand muscle contraction in rehabilitation exercises. The present non-systematic review concerns the use of neuromuscular and musculoskeletal ultrasound imaging in physiotherapy. It covers the use of ultrasonography for assessment and clinical decision-making. It reviews the literature and includes the authors’ own experience with neuromuscular and musculoskeletal ultrasonography. The illustrations come from the authors’ daily practice of musculoskeletal ultrasound imaging. Ultrasound imaging enables physiotherapists to determine the patient's motion potential. It thus facilitates treatment planning for dysfunctional impaired motion. It can provide objective measurement of structures on clinical examination, to confirm or question the results of the usual clinical tests. Monitoring the progression of sonographic signs helps assess the effectiveness of physiotherapy, ensuring a treatment plan optimally adapted to the patient. Musculoskeletal ultrasound imaging, associated to clinical tests, improves the choice of therapeutic strategy following initial work-up and helps guarantee the appropriateness of treatment. However, the use of ultrasound imaging requires an understanding of its principles and limitations, solid knowledge of pathophysiology, and evidence-based application founded on reliable validated methods. All this enables static and dynamic analysis of the anatomical structures concerned by the clinical assessment usually performed in physiotherapy work-up. To ensure financially responsible and evidence-based practice, physiotherapists seek to maximize the effectiveness of their interventions.
Non-applicable.
Factors Correlating Outcome in Young Infants with Congenital Muscular Torticollis
2016, Canadian Association of Radiologists Journal
No previous study using follow-up ultrasonography for evaluating the factors associated with the successful regression of congenital muscular torticollis in young infants has been published. This study aimed to assess clinical factors and sonographic features potentially influencing regression in patients with congenital muscular torticollis.
From January 2010 to December 2012, 80 infants underwent neck ultrasonography because of clinical suspicion of congenital muscular torticollis. We statistically analysed the correlation between complete resolution and clinicosonographic findings when complete resolution was defined as no visible lesion on follow-up ultrasonography.
Of the 80 infants, 61 had congenital muscular torticollis and all were followed up by ultrasonography: 1) 34 underwent physiotherapy, and 27 of them (79.4%) revealed complete resolution in follow-up; 2) 27 did not undergo physiotherapy, and 15 of them (55.6%) showed complete resolution. A statistically significant correlation was found between physiotherapy and complete resolution, but not between complete resolution and patient sex; size, volume, and echogenicity of the lesion; and thickness ratio.
Physiotherapy was the only factor influencing complete resolution in young infants with congenital muscular torticollis.
Aucune étude n'avait encore été publiée sur le recours à une échographie de suivi pour évaluer les facteurs favorisant la régression du torticolis musculaire congénital chez les nourrissons. L’étude visait à analyser les facteurs cliniques et les caractéristiques échographiques susceptibles d'induire une régression chez les patients présentant un torticolis musculaire congénital.
De janvier 2010 à décembre 2012, 80 nourrissons ont subi une échographie cervicale en raison d'une suspicion clinique de torticolis musculaire congénital. La corrélation entre la résolution de l'affection et les résultats clinico-échographiques observés, dans les cas où cette résolution était définie par l'absence de lésion visible à l’échographie de suivi, a fait l'objet d'une analyse statistique.
61 des 80 nourrissons présentaient un torticolis musculaire congénital. Tous ont fait l'objet d'un suivi par échographie. Le suivi a révélé 1) une résolution de l'affection chez 27 (79,4 %) des 34 nourrissons qui ont entrepris un programme de physiothérapie et 2) une résolution de l'affection chez 15 (55,6 %) des 27 nourrissons qui n'ont pas suivi de programme de physiothérapie. Nous avons observé une corrélation statistiquement significative entre la physiothérapie et la résolution de l'affection. Toutefois, aucune corrélation n'a été observée entre la résolution de l'affection et a) le sexe du patient, b) la taille, le volume et l’échogénicité de la lésion ou c) le ratio d’épaisseur.
La physiothérapie s'est avérée être le seul facteur à favoriser la résolution du torticolis musculaire congénital chez les nourrissons.
Torticollis
2012, Pediatric Surgery, 2-Volume Set: Expert Consult - Online and Print
Torticollis
2012, Pediatric Surgery
Clinical features and outcome of physiotherapy in early presenting congenital muscular torticollis with severe fibrosis on ultrasonography: A prospective study
2011, Journal of Pediatric Surgery
Citation Excerpt :
In addition, Cheng et al used their own scoring scale as an outcome parameter that included many subjective findings such as degree of craniofacial asymmetry, residual band, head tilt, and subjective assessment by parents, whereas we used only the objective finding ΔROT. Of specific note, the good clinical outcome observed in infants with severe fibrosis in the SCM (type 3) in the present study differed from that of previous reports in which passive rotation of neck for types 3 and 4 fibrosis did not improve after conservative treatment and showed a higher probability for requiring surgical correction [8,9]. In previous reports, patients with severe fibrosis on US were likely to be older than those with mild fibrosis.
It has been reported that ultrasonography (US) can detect the severity of congenital muscular torticollis (CMT), and severe fibrosis of the sternocleidomastoid (SCM) muscle noted on US is irreversible and likely to require surgery. Clinical outcome of CMT depends mainly on the patient's age, which is also associated with the severity of fibrosis as determined by US. However, there has been no well-designed study to elucidate the true relationship among these factors nor a definite consensus on treatment of young infants with severe fibrosis in the SCM compared with well-documented reports that late cases require surgery.
The purpose of the current study was to investigate whether severity of SCM fibrosis on US is correlated with clinical severity and outcome of standardized physiotherapy in early presenting CMT.
Fifty patients with a palpable neck mass, initial deficit of passive neck rotation (ΔROT) more than 10°, and age less than 3 months were classified into 4 US types according to the severity of fibrosis in the SCM and underwent standardized physiotherapy and regular assessment. Relationship between US types and 2 variables (ΔROT and treatment duration) and success rate of physiotherapy was assessed.
None of the cases was classified as type 4. Type 3 showed greatest ΔROT and longest mean treatment duration. Both variables showed a significant linear trend of association with US types by P for trend (P = .003, P < .001, respectively). Treatment was “successful” in 49 patients (98%).
In young infants with CMT, US can document severity; and an early and adequate physiotherapy is a good treatment option, particularly even in those with severe fibrosis.

View all citing articles on Scopus

^☆: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

View full text

ArticleCorrelation of clinical and ultrasonographic features in congenital muscular torticollis☆

Abstract

J Pediatr Surg

Sternomastoid tumor and muscular torticollis

Clin Orthop Rel Res

Congenital torticollis-a review and result study

Surg Gynecol Obstet

Infantile torticollis: a review of 624 cases

J Pediatr Orthop

Pseudotumor of infancy and congenital muscular torticollis

Am Fam Physician

Congenital torticollis: evaluation by fine-needle aspiration biopsy

Laryngoscope

Congenital muscular torticollis: computed tornographic observation

Am J Dis Child

Sternocleidomastoid fibrosis in congenital muscular torticollis: MR appearance

J Comput Assist Tomogr

Congenital muscular torticolli: Sequela of intrauterine or perinatal compartment syndrome

J Pediatr Orthop

Muscle ultrasonography and computed tomography in elderly trained and untrained women

Muscle Nerve

Musculoskeletal ultrasonography

Radiol Clin North Am

Article
Correlation of clinical and ultrasonographic features in congenital muscular torticollis☆