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Funao H, Isogai N, Otomo N, Yamanouchi K, Mizukoshi R, Fujita N, Ebata S, Ishii K, Yagi M. Clinical Results after Release of Sternocleidomastoid Muscle Surgery for Neglected Congenital Muscular Torticollis-Unipolar vs. Bipolar Release Surgery. J Clin Med 2023; 13:131. [PMID: 38202137 PMCID: PMC10780082 DOI: 10.3390/jcm13010131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/24/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Although the surgical release of the sternocleidomastoid muscle (SCM) is required for residual congenital muscular torticollis (CMT), the surgical outcomes between bipolar and unipolar SCM release remained unclear. The purpose of the present study was to assess surgical outcomes after bipolar and unipolar release of SCM in adolescent/adult patients with neglected CMT. METHODS Twenty-one consecutive adolescent/adult patients with neglected CMT who underwent surgical treatment were enrolled. Clinical and radiographic outcomes were evaluated at preoperative and final follow-up. RESULTS The bipolar release of SCM was performed in 3 patients (B group; males, n = 1, females, n = 2) and the unipolar release of SCM in 18 patients (U group; males, n = 6, females, n = 12). The mean age at surgery was 40.0 ± 17.0 years in Group B, and that was 32.3 ± 13.1 years in Group U (p = 0.47). The mean follow-up period was 16.0 ± 5.7 months in Group B and 10.4 ± 7.6 months in Group U (p = 0.22). Cervicomandibular angle correction rates were comparable at 75.4 ± 2.4% for the B group and 73.1 ± 11.7% for the U group (p = 0.62). There was no significant difference in clinical outcome according to the modified Cheng and Tang score between the two groups (p = 0.89). No major complications arose, although one patient exhibited a transient neurological deficit of the greater auricular nerve, and one patient developed a hematoma in the B group. CONCLUSIONS The unipolar SCM release appeared to be a non-inferiority and less invasive procedure, minimizing surgical scars and avoiding potential auricular nerve damage in adolescent/adult patients with neglected CMT.
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Affiliation(s)
- Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-8686, Japan; (N.I.); (N.O.); (K.Y.); (R.M.); (N.F.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita 286-0124, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-8686, Japan; (N.I.); (N.O.); (K.Y.); (R.M.); (N.F.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Nao Otomo
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-8686, Japan; (N.I.); (N.O.); (K.Y.); (R.M.); (N.F.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Kento Yamanouchi
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-8686, Japan; (N.I.); (N.O.); (K.Y.); (R.M.); (N.F.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita 286-0124, Japan
| | - Ryo Mizukoshi
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-8686, Japan; (N.I.); (N.O.); (K.Y.); (R.M.); (N.F.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita 286-0124, Japan
| | - Naruhito Fujita
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-8686, Japan; (N.I.); (N.O.); (K.Y.); (R.M.); (N.F.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita 286-0124, Japan
| | - Shigeto Ebata
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-8686, Japan; (N.I.); (N.O.); (K.Y.); (R.M.); (N.F.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita 286-0124, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo 160-0016, Japan;
- Society for Minimally Invasive Spinal Treatment (MIST), Tokyo 101-0063, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-8686, Japan; (N.I.); (N.O.); (K.Y.); (R.M.); (N.F.); (S.E.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita 286-0124, Japan
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Minghelli B, Vitorino NGD. Incidence of Congenital Muscular Torticollis in Babies from Southern Portugal: Types, Age of Diagnosis and Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9133. [PMID: 35897505 PMCID: PMC9332427 DOI: 10.3390/ijerph19159133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/14/2022] [Accepted: 07/22/2022] [Indexed: 12/01/2022]
Abstract
Congenital torticollis (CMT) is the most common type of torticollis and is defined as a unilateral contracture of the sternocleidomastoid muscle resulting in lateral head tilt associated with contralateral rotation, and early detection and treatment may present a high probability of recovery of head posture symmetry. This study aimed to verify the incidence of torticollis in babies born in southern Portugal types, age of diagnosis and the risk factors. This study comprised 6565 infants born in the south of Portugal at Algarve University Hospital Center, Portimão unit during a 5-year period (January 2016 to December 2020). The cases diagnosed with torticollis referred to the Pediatrics and Pediatric Physiatrist consultations at this hospital were included. 118 babies—77 (65.3%) male and 41 (34.7%) female—were diagnosed with torticollis. The incidence of a 5-year period was 1.5%. Spontaneous vaginal delivery was prevalent (n = 56; 47.5%), with 106 (89.8%) deliveries with cephalic presentation. 53 (44.9%) cases of torticollis were classified as postural, 37 (31.4%) as muscular torticollis with joint limitation and 28 (23.7%) as congenital torticollis (with the presence of a nodule). Postural torticollis was diagnosed at an average age of 70.14 days, muscular torticollis with joint limitation at an average of 64.12 days and congenital torticollis at 33.25 days (p < 0.001). Plagiocephaly was present in 48 (40.7%) babies with torticollis (p = 0.005) and joint limitation in 53 (44.9%) babies (p < 0.001). The data obtained revealed a low incidence of CMT, with the majority being classified as postural. The age of diagnosis varied between 33 to 70 days from birth. The baby’s gender, mode of delivery and the fetal presentation during delivery did not show a statistically significant association with the presence of torticollis. Despite presenting a low incidence, it is important to mention the importance of professional health intervention in the implementation of prevention strategies.
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Affiliation(s)
- Beatriz Minghelli
- Escola Superior de Saúde Jean Piaget Algarve, Instituto Piaget, 8300-025 Silves, Portugal
- Research in Education and Community Intervention (RECI), Instituto Piaget, 1950-157 Lisbon, Portugal
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Kim OH, Lee SW, Ha EK, Kim JH, Jo YH, Rhie S, Han MY, Chae KY. Neurodevelopmental outcomes and comorbidities of children with congenital muscular torticollis: evaluation using the National Health Screening Program for Infants and Children database. Clin Exp Pediatr 2022; 65:312-319. [PMID: 34886594 PMCID: PMC9171465 DOI: 10.3345/cep.2021.01417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Congenital muscular torticollis (CMT) is a common musculoskeletal disorder occurring at birth or in infancy. PURPOSE This study aimed to investigate the risk of comorbidities in CMT and explore the differences in neurodevelopmental outcomes between children who received physical therapy and those who did not. METHODS Children with CMT born in 2008 and 2009 in Korea were included. CMT was defined as a primary diagnosis of congenital deformity of sternocleidomastoid muscle according to the International Classification of Diseases 10th revision. Here we investigated the associated neurological/musculoskeletal comorbidities of children with CMT versus those of the general population. We divided those with torticollis into treatment and nontreatment groups and assessed their developmental outcomes within both groups of children using the Korean-Ages and Stages Questionnaire (K-ASQ). RESULTS Of the 917,707 children, 0.2% (n=1,719) were diagnosed with CMT. In children with torticollis, the prevalence of congenital hip deformities significantly increased to 4.5% (n=78). The prevalence of congenital head/spine deformities and other congenital malformations of the skull and facial bones increased to 2.6% (n=44), while the prevalence of congenital foot deformities was 2.4% (n=42). The risk ratio (RR) for delayed development based on the K-ASQ was higher for the total assessment (adjusted RR=0.97; 95% confidence interval, 0.93-0.99) in the CMT patients without physical therapy than in those with therapy. There was no significant intergroup difference in the assessment of each developmental area. CONCLUSION The prevalence of comorbid musculoskeletal deformities was higher in children with CMT than in the control group. The risk of developmental delay was higher in children who did not receive physical therapy than in those who did.
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Affiliation(s)
- Og Hyang Kim
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Ju Hee Kim
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Yun Hye Jo
- Department of Global Economic, Gachon University, Seongnam, Korea
| | - Seongyeong Rhie
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Kyu Young Chae
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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Tang W, Li Z, Xu W, Ye Y, Wang H, Wang Y, Shao X, Wang M, Xu J. Effect of massage therapy on infants with congenital muscular torticollis: A retrospective comparative study. Front Pediatr 2022; 10:984675. [PMID: 36699315 PMCID: PMC9869063 DOI: 10.3389/fped.2022.984675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 12/08/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To detect the effect and safety of massage therapy on infants with congenital muscular torticollis. METHODS A total of 56 infants with unilateral congenital muscular torticollis were enrolled in this retrospective comparative study. The subjects were divided in two groups, namely, the control group and the massage group. The control group (n = 28) received the treatment of sternocleidomastoid muscle (SCM) stretching, while the massage group (n = 28) received massage therapy combined with SCM stretching. The following parameters were compared: the cervical range of motion (ROM) and functional level (muscle function scale and ratio of muscle function scale scores). Complications, if any, were also recorded. RESULTS Of the 56 infants, 7 infants (12.5%) underwent surgery with little functional improvement. The total effective rate of conservative treatment was 87.5%. No significance was found in terms of the surgery rate between both groups (14.29 vs. 10.71%, P = 0.693). After treatment, the ROM (including rotation and lateral flexion) and the ratio of muscle function scale scores improved significantly (P < 0.05). In the latest follow-up, the massage group showed a greater improvement in rotation and lateral flexion. However, no significant difference in the muscle function scale score ratio was found (P = 0.126). Importantly, no adverse events related to blood vessels, nerves, and SCM occurred. CONCLUSIONS Providing massage therapy in infants with congenital muscular torticollis is a safe and effective method to improve the cervical range of motion and function. However, this study did not find any decrease in the surgical rate between two groups of patients despite adding such therapy.
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Affiliation(s)
- Wei Tang
- Department of Acupuncture, Moxibustion and Tuina, The First Hospital of Hunan University of Chinese Medicine, Changsha, China.,Department of Acupuncture, Moxibustion and Tuina, The First Affiliated Hospital of Hunan College of Traditional Chinese Medicine, Zhuzhou, China
| | - Zhoujin Li
- Department of Orthopaedics, The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Weihui Xu
- Department of Acupuncture, Moxibustion and Tuina, The First Affiliated Hospital of Hunan College of Traditional Chinese Medicine, Zhuzhou, China
| | - Yong Ye
- Department of Acupuncture, Moxibustion and Tuina, The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Huijuan Wang
- Department of Acupuncture, Moxibustion and Tuina, The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Ying Wang
- Department of Acupuncture, Moxibustion and Tuina, The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Xiangning Shao
- Department of Acupuncture, Moxibustion and Tuina, The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Mengqing Wang
- Department of Acupuncture, Moxibustion and Tuina, The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Jianda Xu
- Department of Orthopaedics, Changzhou Traditional Chinese Medicine Hospital, Changzhou, China
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Zollars JA, Burtner PA, Stockman G, Werbelow P, Swartzentruber J, Lowe JR. Neural and visceral manipulation in infants with congenital muscular torticollis: a feasibility study. J Phys Ther Sci 2020; 32:7-15. [PMID: 32082020 PMCID: PMC7008025 DOI: 10.1589/jpts.32.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/17/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] As an alternative to manual stretching, the aim of this study was to
investigate the feasibility of using neural/visceral manipulation as a safe and effective
intervention to increase neck range of motion of infants with congenital muscular
torticollis. [Participants and Methods] Ten 4-month old infants with congenital muscular
torticollis received eight sessions of neural/visceral manipulation administered for 30–50
minutes without observed pain. Specific palpation techniques addressed restricted tissue
areas of neck, head, trunk and extremities. Neck rotation and lateral flexion were
assessed by still photography and a computer program calculating ROM angles before,
immediately following, and 4 months post intervention. Motor development and social
competence were monitored over time using the Alberta Infant Motor Scale and Bayley-III
Social Emotional Scale. [Results] Results of analysis of variances revealed significant
improvements in passive and active neck rotation and lateral flexion. Significant
increases were also found on the Alberta Infant Motor Scale and Bayley-III
Social-Emotional scale. [Conclusion] Neural/visceral manipulation can be used safely in
infants with congenital muscular torticollis to improve neck range of motion.
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Affiliation(s)
- Jean Anne Zollars
- Physical Therapy, Inc.: 1100 Alvarado Dr. NE, Suite C, Albuquerque, NM 87110, USA
| | - Patricia A Burtner
- Occupational Therapy Graduate Program, Department of Pediatrics, University of New Mexico, USA
| | - Gail Stockman
- Occupational Therapy Graduate Program, Department of Pediatrics, University of New Mexico, USA
| | - Prisca Werbelow
- Occupational Therapy Graduate Program, Department of Pediatrics, University of New Mexico, USA
| | - Jessie Swartzentruber
- Occupational Therapy Graduate Program, Department of Pediatrics, University of New Mexico, USA
| | - Jean R Lowe
- Division of Pediatrics/Neonatology, University of New Mexico, USA
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Luo H, Li T, Wu S, Zhu H, Chen K, Ma L, Lin M. Clinical value of virtual touch tissue imaging quantification in diagnosis and treatment of congenital muscular torticollis in children. Transl Pediatr 2020; 9:13-20. [PMID: 32154131 PMCID: PMC7036642 DOI: 10.21037/tp.2020.01.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the clinical value of virtual touch tissue imaging quantification (VTIQ) in the diagnosis and treatment of congenital muscular torticollis (CMT) in children. METHODS Sixty-two CMT children treated in the clinics of our hospital were collected, and then 62 CMT children treated with manipulation massage were followed up; 23 CMT children receiving surgery in the same period served as controls. Conventional ultrasonography and VTIQ were performed at bilateral sternocleidomastoid muscles (SCM), and the shear wave velocity (SWV) was measured. RESULTS In 62 patients and 23 controls, the average SWV of affected SCM was higher than the contralateral SCM. The difference was statistically significant (P<0.01). There was no marked difference in the SWV of between the affected SCM and healthy SCM after massage (P>0.05). The SWV of SCM after treatment was lower than before treatment. The difference was statistically significant (P<0.01). The SWV of affected SCM in 23 controls was higher than the affected SCM in 62 patients before massage. The difference was statistically significant (P<0.01). CONCLUSIONS VTIQ is helpful for the diagnosis of CMT in children and can also be employed for the monitoring of therapeutic effect.
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Affiliation(s)
- Hongxia Luo
- Department of Ultrasound, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Tianran Li
- Department of Ultrasound, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Senmin Wu
- Department of Ultrasound, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Hui Zhu
- Department of Ultrasound, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Kai Chen
- Department of Ultrasound, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Lie Ma
- Department of Ultrasound, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Miaomiao Lin
- Department of Pediatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
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Sargent B, Kaplan SL, Coulter C, Baker C. Congenital Muscular Torticollis: Bridging the Gap Between Research and Clinical Practice. Pediatrics 2019; 144:e20190582. [PMID: 31350358 PMCID: PMC6855899 DOI: 10.1542/peds.2019-0582] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2019] [Indexed: 12/16/2022] Open
Abstract
Congenital muscular torticollis (CMT) is a common postural deformity evident shortly after birth, typically characterized by ipsilateral cervical lateral flexion and contralateral cervical rotation due to unilateral shortening of the sternocleidomastoid muscle. New evidence is emerging on the pathogenesis of CMT, the negative long-term consequences of delaying intervention, and the importance of early identification and early intervention to maximize outcomes. Our purpose in this article is to inform pediatricians and health care providers about new research evidence and share selected recommendations and implementation strategies specifically relevant to pediatric practice to optimize outcomes and health services for infants with CMT.
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Affiliation(s)
- Barbara Sargent
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California;
| | - Sandra L Kaplan
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
| | - Colleen Coulter
- Department of Orthotics and Prosthetics, Children's Healthcare of Atlanta, Atlanta, Georgia; and
| | - Cynthia Baker
- Department of Pediatrics, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
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Kaplan SL, Coulter C, Sargent B. Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy. Pediatr Phys Ther 2018; 30:240-290. [PMID: 30277962 PMCID: PMC8568067 DOI: 10.1097/pep.0000000000000544] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Congenital muscular torticollis (CMT) is a postural deformity evident shortly after birth, typically characterized by lateral flexion/side bending of the head to one side and cervical rotation/head turning to the opposite side due to unilateral shortening of the sternocleidomastoid muscle; it may be accompanied by other neurological or musculoskeletal conditions. Infants with CMT should be referred to physical therapists to treat these postural asymmetries as soon as they are identified. PURPOSE This update of the 2013 CMT clinical practice guideline (CPG) informs clinicians and families as to whom to monitor, treat, and/or refer and when and what to treat. It links 17 action statements with explicit levels of critically appraised evidence and expert opinion with recommendations on implementation of the CMT CPG into practice. RESULTS/CONCLUSIONS The CPG addresses the following: education for prevention; referral; screening; examination and evaluation; prognosis; first-choice and supplemental interventions; consultation; discontinuation from direct intervention; reassessment and discharge; implementation and compliance audits; and research recommendations. Flow sheets for referral paths and classification of CMT severity have been updated.
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Affiliation(s)
- Sandra L Kaplan
- Department of Rehabilitation and Movement Sciences (Dr Kaplan), Rutgers, The State University of New Jersey, Newark, New Jersey; Orthotics and Prosthetics Department (Dr Coulter), Children's Healthcare of Atlanta, Atlanta, Georgia; Division of Biokinesiology and Physical Therapy at the Herman Ostrow School of Dentistry (Dr Sargent), University of Southern California, Los Angeles, California
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Informing the Update to the Physical Therapy Management of Congenital Muscular Torticollis Evidence-Based Clinical Practice Guideline. Pediatr Phys Ther 2018; 30:164-175. [PMID: 29924060 PMCID: PMC8317609 DOI: 10.1097/pep.0000000000000517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To systematically review the recent evidence on physical therapy (PT) diagnosis, prognosis, and intervention of congenital muscular torticollis to inform the update to the PT management of congenital muscular torticollis evidence-based clinical practice guideline. METHODS From 2012 to 2017, 7 databases were searched for studies that informed PT diagnosis, prognosis, or intervention of infants and children with congenital muscular torticollis. Studies were appraised for risk of bias and quality. RESULTS Twenty studies were included. No studies informed PT diagnosis. Fourteen studies informed prognosis, including factors associated with presence of a sternocleidomastoid lesion, extent of symptom resolution, treatment duration, adherence to intervention, cervical spine outcomes, and motor outcome. Six studies informed intervention including stretching frequency, microcurrent, kinesiology tape, group therapy, and postoperative PT. CONCLUSIONS New evidence supports that low birth weight, breech presentation, and motor asymmetry are prognostic factors associated with longer treatment duration. Higher-level evidence is emerging for microcurrent intervention.
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Jiang B, Zu W, Xu J, Xiong Z, Zhang Y, Gao S, Ge S, Zhang L. Botulinum toxin type A relieves sternocleidomastoid muscle fibrosis in congenital muscular torticollis. Int J Biol Macromol 2018; 112:1014-1020. [PMID: 29447964 DOI: 10.1016/j.ijbiomac.2018.02.077] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 12/20/2022]
Abstract
Congenital muscular torticollis (CMT) is a neck deformity that involves shortening of sternocleidomastoid muscle (SCM) characterized by muscle atrophy and interstitial fibrosis. To investigate wheatear Botulinum toxin type A (BTA) has anti-fibrotic effects in CMT, we established acquired muscular torticollis that mimetics CMT in rabbit by intra-SCM injection of anhydrous alcohol. The treatment groups received BTA (2.5units or 5units) injection into the fibrotic SCM. The shortening and thickening of SCM were recorded by B-mode ultrasound. Changes in Col1A1, Fn, α-SMA expression were determined by immunohistochemistry. In vitro studies, TGF-β induced NIH3T3 fibroblasts were used to evaluate anti-fibrosis effect of BTA. Expression of the myofibroblast marker α-SMA and fibrosis markers Col1A1 and Fn were detected by Western blotting and quantitative RT-PCR. Our results showed that BTA injection attenuated shortening and thickening of fibrotic SCM. Elevated expression of Col1A1, Fn, α-SMA were confirmed in this fibrotic muscle model but reversed after BTA injection. Similar results observed in TGF-β induced NIH3T3 fibroblasts in both mRNA and protein levels. In conclusion, our results suggested that BTA could be a promising agent against SCM fibrosis in CMT through regulating fibroblast and inhibiting myofibroblast differentiation.
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Affiliation(s)
- Banghong Jiang
- Department of Plastic Surgery, 1st Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui 233000, PR China
| | - Wenxuan Zu
- Department of Anatomy, Bengbu Medical College, Bengbu, Anhui 233000, PR China
| | - Jing Xu
- Department of Plastic Surgery, 1st Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui 233000, PR China
| | - Zhuyou Xiong
- Department of Plastic Surgery, 1st Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui 233000, PR China
| | - Yichao Zhang
- Department of Ultrasonography, Bengbu Second People's Hospital, Bengbu, Anhui 233004, PR China
| | - Song Gao
- Department of Plastic Surgery, 1st Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui 233000, PR China
| | - Shuxing Ge
- Department of Plastic Surgery, 1st Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui 233000, PR China
| | - Li Zhang
- Department of Plastic Surgery, 1st Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui 233000, PR China.
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