Early rehabilitation treatment in newborns with congenital muscular torticollis.

BACKGROUND: Congenital Muscular Torticollis (CMT) is the most common form of torticollis in infants; on clinical presentation it is classified into 3 types: 1) postural torticollis, with postural deformity only in the neck; 2) muscular torticollis, where neck deformity is associated with muscle tightness and restricted passive range of motion (ROM); and 3) sternomastoid tumor or pseudotumor, with a fibrotic, sternocleido-mastoid muscle mass and passive ROM limitations.

AIM: The aim of this study was to evaluate the physical therapy outcome of infants with CMT treated either by parents using a home exercise program, or by a physical therapist.

DESIGN: Longitudinal study.

SETTING: Outpatients with CMT at our Department of Physical Medicine and Rehabilitation.

POPULATION: Fifty consecutive newborns with CMT, referred by the primary pediatrician:

METHODS: In our study, 50 infants with CMT were evaluated and treated either by a physical therapist or by parents using a home program.

RESULTS: Sixteen females (32%) and 34 males (68%), aged 10.2 weeks (SD 6.66); 23 of the infants (46%) presented with more severe articular limitations than the others (P=0.002) and were therefore prescribed outpatient treatment by a physical therapist; the remaining 27 less severe cases (54%) were prescribed a home therapy program. 49 infants achieved full resolution after an average of 81.06 days (SD 64.05) of rehabilitation treatment. The group of patients who were treated at home achieved resolution more quickly (72.8 vs. 91.1 days), although statistical significance was not reached.

CONCLUSIONS: Infants with CMT who were treated early, either at home or in the outpatient clinic, completely recovered normal neck movement in a short time. It is important not to discharge patients until they have achieved full resolution of CMT symptoms to exclude the minimal risk of relapse.

CLINICAL REHABILITATION IMPACT: This study demonstrates the importance of early treatment in cases of congenital muscular torticollis.