Intensive physiotherapeutic management of congenital muscular torticollis

Objectives To assess effectiveness of early and intensive physiotherapeutic management of congenital muscular torticollis and determine number of visits to physiotherapy department to achieve maximum clinical improvement in relation to age of initiation of treatment. Setting Physiotherapy department, Base Hospital, Horana. Method A prospective study was done from May to December 2002 on babies brought for treatment of congenital muscular torticollis. Intensive physiotherapy was given by a physiotherapist twice daily for 1 week and the mothers instructed in the procedure. Further physiotherapy was given by mothers at home with regular visits to the physiotherapy department. On complete resolution of torticollis, babies were referred back to the well baby clinic where they were followed up until one year of age. For statistical evaluation, Student’s t-test was used. Results 19 babies, ages ranging from 18-90 days, had been referred for treatment of congenital muscular torticollis during study period. 11 were female. 16 were diagnosed during first 2-3 weeks of life, and 3 at age of 3 months. 11 had left sided sternocleidomastoid tumour, 7 had right sided tumour and one had sternocleidomastoid shortening without a palpable tumour. There were 17 spontaneous vaginal deliveries (16 cephalic, 1 breech) and 2 vacuum extractions. In 14 cases mothers were primigravidae. Infants in whom treatment was initiated within 4 weeks of birth achieved maximum clinical improvement with a mean of 12 (SD 3.3) visits to physiotherapy department. Infants treated after 4 weeks achieved 1 Lecturer, Disability studies unit, Faculty of Medicine, University of Kelaniya, 2 Consultant Paediatrician, Base Hospital, Horana. (Received on 15 November 2003) maximum clinical improvement with a mean of 22 (SD 6.4) visits to physiotherapy department. This is statistically significant (t = 3.81. p<0.01) Conclusions Congenital muscular torticollis is correctable if detected early and physiotherapy commenced forthwith. Awareness programmes for parents and their active participation are essential in terms of full recovery and reduction of number of visits to physiotherapist.