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Snapping during manual stretching in congenital muscular torticollis
J C Cheng1, T M Chen, S P Tang
1Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Shatin, NT.
Insights
Snapping of the sternocleidomastoid muscle during infant congenital muscular torticollis treatment indicates muscle rupture but does not affect long-term outcomes. This finding aids in understanding treatment responses and potential complications in pediatric physical therapy.
Area of Science:
- Pediatric Physical Therapy
- Musculoskeletal Disorders
- Infant Health
Background:
- Congenital muscular torticollis (CMT) is common in infants.
- Manual stretching is a primary treatment for CMT.
- Sternocleidomastoid muscle snapping can occur during manipulation.
Purpose of the Study:
- To investigate causes and clinical significance of sternocleidomastoid muscle snapping during CMT treatment.
- To compare outcomes in infants with and without snapping during manual stretching.
Main Methods:
- Prospective study of 455 infants (<1 year) with CMT over 13 years.
- Standardized gentle manual stretching program.
- Comparison of 41 infants with snapping versus 404 without snapping.
Main Results:
- Snapping associated with more severe sternomastoid tumors, higher hip dysplasia incidence, earlier presentation, and shorter treatment duration.
- No significant difference in final assessment scores or surgery rates between groups after 3.5 years follow-up.
- Clinical and ultrasonographic evidence suggests partial/complete sternocleidomastoid muscle rupture during snapping.
Conclusions:
- Unintentional snapping during CMT treatment signifies sternocleidomastoid muscle rupture.
- Snapping does not lead to adverse long-term outcomes in pediatric patients.
- Understanding snapping aids in managing infant torticollis treatment.
Abstract:
Manual stretching frequently is used in the treatment of congenital muscular torticollis in infants. During manipulation, it is not uncommon for the sternocleidomastoid muscle to snap or suddenly give way. The main objective of this study was to evaluate the predisposing causes and clinical significance of such snapping. Four hundred fifty-five patients younger than 1 year of age with congenital muscular torticollis treated with a standardized gentle manual stretching program during a 13-year period were studied. Using prospective standardized assessment parameters, the pretreatment, treatment, and followup results of a group of 41 patients with snapping detected during treatment were compared with the results of a group of 404 patients without snapping during treatment. The group with snapping was associated with a more severe sternomastoid tumor, higher incidence of hip dysplasia, earlier clinical presentation, and shorter duration of treatment. With a mean followup of 3.5 years, the group with snapping was not different from the group that had no snapping in the final assessment score and percentage requiring surgery. From this study, unintentional snapping during the gentle manipulation treatment of congenital muscular torticollis has clinical and ultrasonographic evidence of partial or complete rupture of the sternocleidomastoid muscle. No long-term deleterious effect on the outcome was observed after the snapping.