Recalcitrant Torticollis: A Formidable Treatment Challenge

Area of Science:

• Pediatric Physical Therapy
• Developmental Pediatrics
• Rehabilitation Medicine

Background:

• Recalcitrant torticollis (RT) lacks evidence-based guidelines, persisting past one year despite conservative care.
• Current recommendations include physical therapy (PT), occupational therapy (OT), botulinum toxin injection (BTI), and surgery for severe cases.

Purpose of the Study:

• To evaluate the effectiveness of conservative therapies for recalcitrant torticollis.
• To identify factors influencing treatment outcomes in infants with persistent torticollis.

Main Methods:

• Retrospective single-center study of 77 patients diagnosed before age one with RT.
• Inclusion criteria: persistent symptoms past one year despite conservative treatment.
• Data collected on diagnosis age, therapies received, and outcomes.

Main Results:

• Most patients (96.1%) received physical therapy for an average of 13.3 months.
• Conservative modalities resolved symptoms in 51.2% and improved symptoms in 45.5%.
• Botulinum toxin injection and surgery were used in a small number of severe cases.

Conclusions:

• Recalcitrant torticollis requires diligent, multidisciplinary care.
• Early conservative therapy initiated before age one significantly improves outcomes.
• Prompt intervention can lead to symptom resolution, often precluding advanced treatments.