Early screening, diagnosis, and intervention for congenital muscular torticollis (CMT) in infants are crucial for improving clinical outcomes. However, in China, limited awareness of CMT among child healthcare institutions and caregivers, as well as inconsistent professional standards among rehabilitation personnel, pose significant challenges to the effective diagnosis and management of CMT. The "Physical therapy management of congenital muscular torticollis: a 2024 evidence-based clinical practice guideline from the American Physical Therapy Association Academy of Pediatric Physical Therapy" includes 17 action statements, primarily addressing the prevention, identification, assessment, and intervention of CMT. This guideline is expected to facilitate early detection of CMT in infants, enhance the treatment capabilities of physical therapists, and improve clinical outcomes. This article provides an interpretation of the guideline in the context of the current status of CMT diagnosis and management in China, aiming to offer a reference for improving the ability of primary child healthcare providers and physical therapists to recognize and manage CMTropriately.
Humans ; Torticollis/diagnosis* ; Physical Therapy Modalities ; Practice Guidelines as Topic ; Infant ; United States

While congenital muscular torticollis (CMT) can occur along with other conditions, such as clavicle fracture or brachial plexus injury, these conditions exist outside the sternocleidomastoid muscle (SCM). We present a rare case with concurrence of CMT and a malignant tumor inside the same SCM, along with serial clinical and radiological findings of the atypical features of CMT. The malignant tumor was in fact a low-grade fibromyxoid sarcoma. To the best of our knowledge, the current case is the first of a concurrent condition of CMT inside the SCM. This case suggests that concurrent conditions could exist either inside or outside the SCM with CMT. Therefore, a thorough evaluation of SCM is required when subjects with CMT display atypical features, such as the increase of mass or poor response to conservative therapy. In that case, appropriate imaging modalities, such as ultrasonogram or magnetic resonance imaging, are useful for differential diagnosis.
Brachial Plexus ; Clavicle ; Diagnosis, Differential ; Fibrosarcoma ; Magnetic Resonance Imaging ; Sarcoma ; Torticollis ; Ultrasonography

OBJECTIVE: To determine which factors affect the rehabilitation duration in patients with congenital muscular torticollis (CMT) and to predict the duration of rehabilitation and prognosis. METHODS: One hundred and eighteen patients (79 males and 39 females) who were diagnosed with CMT and received physical therapy were enrolled in this study. We retrospectively reviewed the information in terms of sex, gestational age, birth weight, methods of delivery, fetal presentation, age at diagnosis, the affected sternocleidomastoid (SCM) muscle site, SCM muscle thickness, ratio of muscle thickness on the affected side to that on the unaffected side (called the 'abnormal/normal [A/N] ratio'), and range of motion for cervical rotation and side bending. RESULTS: The SCM muscle thickness and A/N ratio had a positive linear relationship with the rehabilitation duration. Patients who were in the breech position needed longer rehabilitation. The birth weight and age at diagnosis were negatively correlated with the rehabilitation duration. However, the cervical range of motion, mass site, sex, gestational age, and methods of delivery were not correlated with the rehabilitation duration. CONCLUSION: Patients with a thicker SCM, lower birth weight, and history of breech delivery had a longer rehabilitation duration.
Birth Weight ; Diagnosis ; Female ; Gestational Age ; Humans ; Labor Presentation ; Male ; Pregnancy ; Prognosis ; Range of Motion, Articular ; Rehabilitation* ; Retrospective Studies ; Torticollis*

PURPOSE: To analyze the clinical features and treatment outcome of Langerhans' cell histocytosis. MATERIALS AND METHODS: From August 1996 to June 2013, 28 patients who histologically proven with LCH were analyzed of medical records, radiography, pathologic character retrospectively. RESULTS: A total of 28 cases of LCH including 22 child has been reported. Onset age was 0.6 to 51 years old, occurred in the average age was 14.8 years. Follow-up period was 6 months to 134 months average was 44.6 months. The M:F ratio was 2.5:1. The initial symptoms was pain in 18 cases, 5 cases of pathologic fracture, 3 case of palpable mass, 1 case of discovered by accident in radiography, 1 case of torticollis. In radiological examination osteolysis was seen all cases, 7 cases showed a periosteal reaction, 1 case showed soft tissue extension. Clinical type of all cases were eosinophilic granuloma. 25 cases were classified as unifocal disease and 3 cases were multifocal single systemic diseases. In all cases, incisional biopsy was performed. After histologic confirmed, 14 cases was treated with curettage or surgical excision of the lesion and the other 14 cases were followed up without treatment. There is no death during follow up period. 11 cases has no radiological improvement after 3-6 months observation, intralesional steroid injection was performed. CONCLUSION: Patients with LCH who has rapid systemic onset is very rare, so if you meet the young children who suspected LCH, you shoulder avoid the examination which cause excessive radiation exposure to the young patient. In order to confirm the diagnosis of disease, biopsy is needed. Close observation after confirmed by histological method will bring the satisfactory results. But the patients who had pathologic fracture or wide bone destruction already may need curettage and bone grafting to lesion or internal fixation. The lesion which has no radiological improvement after 3-6 months observation or appear with pain interferes daily life may need local steroid injection as a good treatment.
Age of Onset ; Biopsy ; Bone Transplantation ; Child ; Curettage ; Diagnosis ; Eosinophilic Granuloma ; Follow-Up Studies ; Fractures, Spontaneous ; Histiocytosis, Langerhans-Cell ; Humans ; Medical Records ; Osteolysis ; Radiography ; Retrospective Studies ; Shoulder ; Torticollis ; Treatment Outcome*

Child, Preschool ; Diagnosis, Differential ; Electroencephalography ; Electroretinography ; Eye Movements ; Head Movements ; Humans ; Infant ; Infant, Newborn ; Nystagmus, Pathologic ; diagnosis ; etiology ; physiopathology ; Retinal Diseases ; diagnosis ; physiopathology ; Risk Factors ; Spasms, Infantile ; diagnosis ; etiology ; physiopathology ; Torticollis ; etiology ; physiopathology

Osteoblastomas are rare neoplasms of the spine. The majority of the spinal lesions arise from the posterior elements and involvement of the corpus is usually by extension through the pedicles. An extremely rare case of isolated C2 corpus osteoblastoma is presented herein. A 9-year-old boy who presented with neck pain and spasmodic torticollis was shown to have a lesion within the corpus of C2. He underwent surgery via an anterior cervical approach and the completely-resected mass was reported to be an osteoblastoma. The pain resolved immediately after surgery and he had radiologic assessments on a yearly basis. He was symptom-free 4 years post-operatively with benign radiologic findings. Although rare, an osteoblastoma should be considered in the differential diagnosis of neck pain and torticollis, especially in patients during the first two decades of life. The standard treatment for osteoblastomas is radical surgical excision because the recurrence rate is high following incomplete resection.
Child ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Neck Pain ; Osteoblastoma ; Osteoma, Osteoid ; Recurrence ; Spine ; Torticollis

STUDY DESIGN: A case report. OBJECTIVES: This case report presents a child who was treated conservatively after having being diagnosed with cervical intervertebral disc calcification. SUMMARY OF LITERATURE REVIEW: Cervical intervertebral disc calcification is considered as a degenerative change of spine. It is common in adults and in most cases, no symptoms are observed. In children, by contrast, it is a rare condition and frequently accompanies symptoms such as severe neck pain and dysphagia. MATERIALS AND METHODS: A 7-year-old male patient who suffered from neck pain and torticollis without trauma had been diagnosed with cervical intervertebral disc calcification and was treated conservatively. He was discharged after symptom relief, and has been followed up and observed in our outpatient department. RESULTS: The improvements of symptom and radiographic findings were found in the month follow up. CONCLUSIONS: Cervical intervertebral disc calcification shows similar symptoms to laryngopharyngeal abscess, traumatic injury and infective spondylitis, but through careful physical examination and radiologic evaluation, differential diagnosis is possible. After diagnosis, conservative treatment alone is sufficient. Antibiotic usage and surgical treatment are avoidable.
Abscess ; Adult ; Child ; Diagnosis, Differential ; Humans ; Intervertebral Disc ; Male ; Neck Pain ; Outpatients ; Physical Examination ; Spine ; Spondylitis ; Torticollis

OBJECTIVE: To present the clinical characteristics of abnormal posture of the head and neck (APHN) caused by unilateral superior oblique palsy (USOP) for differential diagnosis of childhood APHN. METHOD: The medical charts of children who came to Department of Physical Medicine and Rehabilitation, Ajou University Medical Center from 2003 to 2008 for APHN were reviewed with special reference to ocular causes of APHN. Children who showed a positive Bielschowsky's head tilt test were strongly suspected to have USOP. In-depth ophthalmic evaluations were done after 6 months of age to identify USOP for those children. The clinical characteristics of children with USOP were compared with those of children with congenital muscular torticollis. RESULTS: Sixteen children were diagnosed with APHN related to ocular causes. Seven children out of 16 (43.8%) had APHN secondary to USOP, which was the most common ocular cause of APHN. The initial clinical presentation of 7 children with USOP was contralateral laterocollis toward the shoulder on the non-USOP side at a mean age of 15.57+/-12.55 months; USOP was diagnosed at a mean age of 19.07+/-11.29 months. APHN was aggravated by staring at objects, and craniofacial asymmetry was not evident at this age compared to children with congenital muscular torticollis. CONCLUSION: The clinical characteristics of USOP were presented, which showed laterocollis toward the shoulder of non-USOP. Differential diagnosis of APHN is critical for proper management for APHN and high index of suspicion for USOP by non-ophthalmologic physicians could make earlier diagnosis of USOP possible.
Academic Medical Centers ; Child ; Diagnosis, Differential ; Head ; Humans ; Neck ; Paralysis ; Physical and Rehabilitation Medicine ; Porphyrins ; Posture ; Shoulder ; Strabismus ; Torticollis

Congenital muscular torticollis (CMT) is called 'pseudotumor of infancy' because it is commonly discovered and diagnosed within 14~28 days after birth as a sternomastoid tumor. We report two cases of CMT which presented as head tilt without any palpable neck mass immediately after birth but later developed into sternomastoid tumors. Serial ultrasonography confirmed increased echogenicities of the sternocleidomastoid muscles. We think that these findings are prodromal signs of sternomastoid tumors. Close physical examination by a neonatologist is crucial for an early diagnosis of CMT. Neonates with head tilt and increased ecogenicity of the sternocleidomastoid muscle on ultrasonography should be carefully followed up to see whether neck mass develops later. The authors suggest that CMT is not a static entity but rather one that progress to mass alteration after birth.
Early Diagnosis ; Head ; Humans ; Infant, Newborn ; Muscles ; Neck ; Parturition ; Physical Examination ; Prodromal Symptoms ; Torticollis

Abnormal posture of the head and neck can happen to anybody from neonates to adults, which requires appropriate interventions according to etiologies. Congenital muscular torticollis is the most common cause of abnormal posture of the head and neck in infancy, where early intervention as soon as possible is critical for better therapeutic outcome. Childhood laterocollis is heterogeneous condition, which needs etiological diagnosis for the proper management. Cervical dystonia is the most common form of focal dystonia and an overview on clinical presentations and therapeutic options including chemodenervation with botulinum toxin injection was provided. Abnormal posture of the head and neck of acute onset could be a sign of serious conditions and needs differential diagnosis.
Adult ; Botulinum Toxins ; Diagnosis, Differential ; Dystonic Disorders ; Early Intervention (Education) ; Head ; Humans ; Infant, Newborn ; Neck ; Nerve Block ; Posture ; Torticollis