A Clinical Comparative Study of Ultrasound-Normal Versus Ultrasound-Abnormal Congenital Muscular Torticollis.
OBJECTIVE
To investigate the clinical features and outcome of outpatient-based physiotherapy (manual stretch) of congenital muscular torticollis (CMT) with passive neck motion limitation (≥ 10°) according to whether the finding on ultrasonography (US) is normal or abnormal.


METHODS
Case-control study.


METHODS
Institutional practice.


METHODS
A total of 149 patients with CMT who met eligibility criteria were included: age at presentation ≤ 6 months, limitation of passive neck rotation (ΔROT) or lateral flexion (ΔLAT) ≥ 10°, and completion of our outpatient-based physiotherapy program.


METHODS
Patients were allocated to the US-normal or US-abnormal group. Patients underwent physiotherapy and were followed-up monthly until ΔROT and ΔLAT were ≤ 5° or did not respond to treatment.


METHODS
Baseline characteristics, initial ΔROT and ΔLAT, age at presentation, treatment durations, and success rates of physiotherapy were compared between 2 groups. Treatment duration was adjusted for initial ΔROT, ΔLAT, and age at presentation using analysis of covariance.


RESULTS
Mean initial ΔROT and ΔLAT in US-abnormal (28.5°; 17.0°) were greater than in US-normal (7.9°, P < .001; 12.3°, P = .001, respectively). Mean age at presentation was older in US-normal (3.8 months) than in US-abnormal (1.8 months, P < .001). Treatment duration was shorter in the US-normal (5.1 weeks) than US-abnormal (14.9 weeks, P < .001). Adjusted treatment duration was also shorter in US-normal (9.7 weeks) than US-abnormal (13.8 weeks, P < .05). The success rates of physiotherapy were 95% in US-abnormal and 100% in US-normal. Two of 6 treatment failures in the US-abnormal group underwent surgery.


CONCLUSIONS
In CMT with passive neck motion limitation (≥ 10°), patients in the US-normal group demonstrated lesser passive neck motion limitation and older age at presentation than US-abnormal. It seems that US-normal showed shorter treatment duration irrespective of severity of neck motion limitation and age at presentation. Additionally, manual stretching applied before 6 months of age appears to show generally good outcome regardless of US findings.
Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, 29 Saemunanro, Jongno-gu, Seoul, South Korea(∗). Electronic address: yongtaek1.lee@gmail.com.
Yong-Taek
YT
Lee
Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea(†).
Jong-Wan
JW
Park
Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea(‡).
Mikyung
M
Lim
Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea(§).
Kyung Jae
KJ
Yoon
Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea(‖).
Yong Bum
YB
Kim
Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea(¶).
Pil-Wook
PW
Chung
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea(#).
Hee-Jin
HJ
Park
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea(∗∗).
So-Yeon
SY
Lee
D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009333:Neck / Q000000981:diagnostic imaging*; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D013997:Time Factors; D014103:Torticollis / Q000151:congenital* / Q000175:diagnosis / Q000534:rehabilitation; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*