Article

OBJECTIVE: To investigate the clinical features and outcome of outpatient-based
physiotherapy (manual stretch) of congenital muscular torticollis (CMT) with
passive neck motion limitation (>/=10 degrees ) according to whether the finding
on ultrasonography (US) is normal or abnormal.
DESIGN: Case-control study.
SETTING: Institutional practice. PARTICIPANTS: A total of 149 patients with CMT
who met eligibility criteria were included: age at presentation </=6 months,
limitation of passive neck rotation (DeltaROT) or lateral flexion (DeltaLAT)
>/=10 degrees , and completion of our outpatient-based physiotherapy program.
INTERVENTIONS: Patients were allocated to the US-normal or US-abnormal group.
Patients underwent physiotherapy and were followed-up monthly until DeltaROT and
DeltaLAT were </=5 degrees or did not respond to treatment. MAIN OUTCOME
MEASUREMENTS: Baseline characteristics, initial DeltaROT and DeltaLAT, age at
presentation, treatment durations, and success rates of physiotherapy were
compared between 2 groups. Treatment duration was adjusted for initial DeltaROT,
DeltaLAT, and age at presentation using analysis of covariance. RESULTS: Mean
initial DeltaROT and DeltaLAT in US-abnormal (28.5 degrees ; 17.0 degrees ) were
greater than in US-normal (7.9 degrees , P < .001; 12.3 degrees , P = .001,
respectively). Mean age at presentation was older in US-normal (3.8 months) than
in US-abnormal (1.8 months, P < .001). Treatment duration was shorter in the
US-normal (5.1 weeks) than US-abnormal (14.9 weeks, P < .001). Adjusted treatment
duration was also shorter in US-normal (9.7 weeks) than US-abnormal (13.8 weeks,
P < .05). The success rates of physiotherapy were 95% in US-abnormal and 100% in
US-normal. Two of 6 treatment failures in the US-abnormal group underwent
surgery. CONCLUSIONS: In CMT with passive neck motion limitation (>/=10 degrees), patients in the US-normal group demonstrated lesser passive neck motion
limitation and older age at presentation than US-abnormal. It seems that
US-normal showed shorter treatment duration irrespective of severity of neck
motion limitation and age at presentation. Additionally, manual stretching
applied before 6 months of age appears to show generally good outcome regardless
of US findings.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS