A Clinical Comparative Study of Ultrasound‐Normal Versus Ultrasound‐Abnormal Congenital Muscular Torticollis. Issue 3 (7th August 2015)

• Record Type: Journal Article
• Authors: Lee, Yong‐Taek; Park, Jong‐Wan; Lim, Mikyung; Yoon, Kyung Jae; Kim, Yong Bum; Chung, Pil‐Wook; Park, Hee‐Jin; Lee, So‐Yeon
• Is Part Of: PM&R. Volume 8:Issue 3(2016)
• Page Start: 214
• Page End: 220
• Publication Date: 2015-08-07
• Subjects: Medical rehabilitation -- Periodicals; Physical therapy -- Periodicals; Physical Therapy Modalities -- Periodicals; 615.5
• DOI: 10.1016/j.pmrj.2015.07.014
• Languages: English
• ISSNs: 1934-1482

Abstract

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 the US‐abnormal group 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.