Correlation of clinical and ultrasonographic features in congenital muscular torticollis

Objective: To find the relationship between the ultrasonographic pictures a nd the clinical features of patients with congenital muscular torticollis ( CMT). Design: Prospective survey of patients with clinically suspected CMT by hig h-resolution ultrasonography. Setting: Rehabilitation department of a tertiary care center. Participants: Two hundred fifty-six CMT patients, from the ages of 9 days t o 16yrs, with a mean follow-up period of 6.7 months. Main Outcome Measures: Correlation of the ultrasound appearance of the invo lved sternocleidomastoid (SCM) muscles with clinical features. The patholog ic findings in diseased muscles from patients who underwent surgical interv ention were also evaluated. Results: Muscle abnormalities were identified ultrasonographically in 218 C MT patients (85%) and were classified into four types: a fibrotic mass in t he involved muscle (type I, 15%); diffuse fibrosis mixing with normal muscl e (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 w ith 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 statisticall y significant. Conclusion: Ultrasonography can precisely identify pathologic changes in th e involved SCM muscle of CMT patients, Type III and IV patients are more li kely to require surgical intervention. (C) 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.