Cleveland Clinic Children's Outcomes
Pediatric Therapy Services
2017 - 2019
Torticollis (neck tightness presenting as asymmetrical positioning) is often categorized into two types: congenital muscular torticollis and positional torticollis. Congenital muscular torticollis (CMT) results in a postural asymmetry evident shortly after birth, correlated with birth trauma or positioning in utero. It results in a shorting or excessive contraction of the sternocleidomastoid muscle in the neck. Positional torticollis often appears within the first few months after birth and is usually caused by asymmetrical positioning of an infant when sleeping or in supported sitting. Infants with both types of torticollis present with reduced cervical range of motion and an asymmetrical head or neck position.
Since June 1st, 2017, 864 children diagnosed with torticollis received physical therapy evaluations; of those children, 53.9% presented with left-sided torticollis and 46.1% with right-sided torticollis.
Of the total patients evaluated, 575 had completed treatments (evaluation and discharge). For this data, inclusion criteria included the following: a diagnosis code of M43.6 (torticollis, unspecified) or Q68.0 (congenital musculoskeletal deformities of sternocleidomastoid muscle), < 12 months of age at the time of initial evaluation, and discharge due to improved muscle function and range of motion. Pre- and post assessments included the Muscle Function Scale (MFS), a measure of head righting and cervical range of motion.
The Muscle Function Scale (MFS) is a tool used to assess the function of the lateral flexors of the neck in infants, using a scale of 0 to 6, with higher scores indicating better muscle function. A favorable outcome for the MFS is a Grade 6. A sample of patients (N=254) at evaluation had a MFS of 1, 2, or 3. Upon discharge, 165 of those patients improved to a Grade 6. These numbers indicate that 65% of patients had the best possible outcome and 94 % demonstrated an improvement.
++Muscle Function Scale Legend++
1=Head below the horizontal
2= Head in the horizontal
3= Head slightly over the horizontal
4= Head high over the horizontal but below 45◦
5= Head high over the horizontal and over 45◦
6 = Head very high over the horizontal
The scale runs from Grade 1 (most severe) to Grade 6 (least severe).
Of the 575 patients who completed treatment, including evaluation and discharge, only 430 were used for this data. Patients who were treated for 3 months or less were considered outliers. These outliers were removed due to not completing the recommended plan of care required to achieve desired outcomes. Based on the above inclusion criteria, the average age at referral was 3.66 months and average age at discharge was 11.64 months. The results indicate that earlier referral and treatment results in better outcomes and earlier discharge age.
In 2018, 165 patients were referred for Torticollis treatment at 3 months of age or earlier. In 2019, that number increased to 236 patients. This trend towards earlier referrals helps support the claim that earlier access to care results in younger age at discharge.
|Age Range at Referral||Average Age at Referral||Average Age at Discharge|