The clinical presentation and outcome of treatment of congenital muscular torticollis in infants - A study of 1,086 cases

Background/Purpose: The main objectives of this study were to define the cl inical patterns and characteristics of congenital muscular torticollis (CMT ) presented in the first year of life and to study the outcome of different treatment methods. Methods: This is a prospective study of all CMT patients seen in 1 center o ver a 12-year period with uniform recording system, assessment methods, and treatment protocol. Results: From a total of 1,086 CMT infants, 3 clinical subgroups of sternom astoid tumor (SMT; 42.7%), muscular torticollis (MT; 30.6%), and postural t orticollis (POST; 22.1%) were identified. The SMT group was found to presen t earlier within the first 3 months and was associated with higher incidenc e of breech presentation (19.5%), difficult labor (56%), and hip dysplasia (6.81%). Severity of limitation of passive neck rotation range (ROTGp) was found to correlate significantly with the presence of SMT, bigger tumor siz e, hip dysplasia, degree of head tilt, and craniofacial asymmetry. Conclusions: A total of 24.5% of the patients with initial deficits of pass ive rotation of less than 10 degrees showed excellent and good outcome with active home positioning and stimulation program. The remaining cases with rotation deficits of over 10 degrees and treated with manual stretching pro gram showed an overall excellent to good results in 91.1% with 5.1% requiri ng subsequent surgical treatment. The most important prognostic factors for the necessity of surgical treatment were the clinical subgroup, the ROTGp, and the age at presentation (P < .001). Copyright (C) 2000 by W.B. Saunder s Company.