Bilateral congenital muscular torticollis in infants, report of two cases

Abstract

Background: Congenital muscular torticollis (CMT) is a well-known diagnosis among physiotherapists specializing in pediatric care, especially when working with infants. However, knowledge of bilateral torticollis is limited. The purpose of this article was to describe how bilateral torticollis may present itself clinically.

Case: Case I describes an infant with CMT with a sternocleidomastoid tumor (SMT) on the right side, with some limitation in rotation towards the right side and in lateral flexion towards the left side, the muscle on the right side was shortened. While sitting with support, he tilted his head to the left and was stronger in the lateral flexors on the left side which fits well with postural left-sided torticollis. The other infant had bilateral muscular torticollis, the sternocleidomastoid muscle had thickened bilaterally, and both active and passive rotations were affected. The head was held in flexion, and active rotation was severely limited on both sides. For both cases the therapeutic interventions were to gain a normal range of motion (ROM) and a good head position.

Conclusions: CMT can appear in different ways and may be bilateral. Both infants gained good ROM and better head position, however case I still needs some training. To gain more knowledge about bilateral CMT, we should follow these cases over a longer period of time. It is important to communicate and discuss our experiences with each other to understand rare cases of CMT.

Keywords: Torticollis; bilateral; infant; physiotherapy.

Figure 1.. Case I, in the prone position, showed lateral flexion of the head to the right and rotation to the left.

This is agreeable with right-sided torticollis. I confirm that I have obtained permission to use this image from the parents of the patient included in this presentation.

Figure 2.. Case I in supported sitting position, lateral flexion of the head to the left and rotation to the right.

This is agreeable with left-sided torticollis. I confirm that I have obtained permission to use this image from the parents of the patient included in this presentation.

Figure 3.. A. Case I test with the muscle function scale (MFS) left side scoring 3, i.e., left side is stronger than the right side. B. Case I test with the muscle function scale (MFS) right side scoring 2, i.e., right side is weaker than the left side.

This is agreeable with left-sided torticollis Infants in general is righting the trunk to some extent in addition to righting the head, especially with higher scores. I confirm that I have obtained permission to use this image from the parents of the patient included in this presentation.

Figure 4.. Muscle function scale.

When the muscle function scale (MFS) is used, the infant is held in a vertical position and then lowered to the horizontal position in front of a mirror. The head position is observed and both sides are tested. Scores are given according to the head position in relation to the horizontal line. The infant must be observed with the head held in the same position for five seconds to obtain the score at that level. This figure has been reproduced/adapted from Ohman et al. (2009). Reprinted by permission of Informa UK Limited, trading as Taylor & Francis Group, www.tandfonline.com.

Figure 5.. Front view of Case II, head in flexion due to bilateral torticollis.

I confirm that I have obtained permission to use this image from the parents of the patient included in this presentation.

Figure 6.. Side view of Case II, head in flexion and only attempts to rotate the head.

I confirm that I have obtained permission to use this image from the parents of the patient included in this presentation.

Figure 7.. Case II rotation of the head after application of kinesiology tape, relaxing technique cross over the sternocleidomastoid muscle.

I confirm that I have obtained permission to use this image from the parents of the patient included in this presentation.