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      The value of high-frequency and color Doppler ultrasonography in diagnosing congenital muscular torticollis

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          Abstract

          Background

          Congenital muscular torticollis (CMT) is a relatively common neck deformity in infancy. The aim of our research was to determine the value of high-frequency and color Doppler ultrasonography in diagnosing CMT.

          Methods

          Patients with a clinical suspicion of CMT underwent an ultrasound examination before diagnosis, and the sonographic characteristics were analyzed and compared with the clinical findings.

          Results

          The sensitivity and specificity of an ultrasound diagnosis for CMT was 95.83% and 83.33%, respectively. The patients were divided into 2 groups based on the stage of the disease: the early-stage group (age <1 year) and the late-stage group(age ≥1 year). Differences existed between the two groups with respect to sonographic findings and clinical characteristics. The sonographic characteristics of the early-stage group included local thickening of the sternocleidomastoid muscle (SCM), weak or uneven echoes, and blood flow signals around or inside most of the lesions. The sonographic characteristics of the late-stage group included diffusely hyperechoic, or cord-like hyperechoic signals inside the muscle layer without significant blood flow signals.

          Conclusions

          Different stage of CMT patients had different sonographic characteristics. High-frequency and color Doppler ultrasonography can serve as adjunct confirmation tool for the diagnosis of CMT.

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          Most cited references 20

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          Musculoskeletal ultrasound including definitions for ultrasonographic pathology.

          Ultrasound (US) has great potential as an outcome in rheumatoid arthritis trials for detecting bone erosions, synovitis, tendon disease, and enthesopathy. It has a number of distinct advantages over magnetic resonance imaging, including good patient tolerability and ability to scan multiple joints in a short period of time. However, there are scarce data regarding its validity, reproducibility, and responsiveness to change, making interpretation and comparison of studies difficult. In particular, there are limited data describing standardized scanning methodology and standardized definitions of US pathologies. This article presents the first report from the OMERACT ultrasound special interest group, which has compared US against the criteria of the OMERACT filter. Also proposed for the first time are consensus US definitions for common pathological lesions seen in patients with inflammatory arthritis.
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            Congenital muscular torticollis: current concepts and review of treatment.

             Phuong Do (2006)
            The purpose of this review is to better understand the spectrum of disease in torticollis, which is the third most common pediatric orthopaedic diagnosis in childhood. Besides the benign muscular tightness of the sternocleidomastoid muscle leading to the classic head position, the differential diagnosis of the wry neck include sequelae to inflammatory, ocular, neurologic or orthopedic diseases. Patients present with a stiff and tilted neck, and therefore require a thorough and systematic work-up, including a complete physical and neurologic examination and cervical spine radiographs. Recent findings show that magnetic resonance imaging of the brain and neck is no longer considered cost-effective, or necessary, in congenital muscular torticollis. Observation and physical therapy, with or without bracing, is usually an effective treatment in most cases, especially if instituted within the first year of life. Botox has recently been shown to be an effective intermediate method of treatment for more resistant cases of congenital muscular torticollis. In those presenting after the age of 1 year, there is an increased rate of sternocleidomastoid muscle lengthening. The lengthening may improve the range of motion, but not necessarily the plagiocephaly, facial asymmetry, or cranial molding. It is important to differentiate muscular from nonmuscular torticollis. Congenital muscular torticollis is benign; missing a case of nonmuscular torticollis could be potentially life threatening.
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              The clinical presentation and outcome of treatment of congenital muscular torticollis in infants--a study of 1,086 cases.

              The main objectives of this study were to define the clinical patterns and characteristics of congenital muscular torticollis (CMT) presented in the first year of life and to study the outcome of different treatment methods. This is a prospective study of all CMT patients seen in 1 center over a 12-year period with uniform recording system, assessment methods, and treatment protocol. From a total of 1,086 CMT infants, 3 clinical subgroups of sternomastoid tumor (SMT; 42.7%), muscular torticollis (MT; 30.6%), and postural torticollis (POST; 22.1%) were identified. The SMT group was found to present earlier within the first 3 months and was associated with higher incidence of breech presentation (19.5%), difficult labor (56%), and hip dysplasia (6.81%). Severity of limitation of passive neck rotation range (ROTGp) was found to correlate significantly with the presence of SMT, bigger tumor size, hip dysplasia, degree of head tilt, and craniofacial asymmetry. A total of 24.5% of the patients with initial deficits of passive rotation of less than 10 degrees showed excellent and good outcome with active home positioning and stimulation program. The remaining cases with rotation deficits of over 10 degrees and treated with manual stretching program showed an overall excellent to good results in 91.1% with 5.1% requiring subsequent surgical treatment. The most important prognostic factors for the necessity of surgical treatment were the clinical subgroup, the ROTGp, and the age at presentation (P < .001).
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                Author and article information

                Journal
                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central
                1471-2474
                2012
                26 October 2012
                : 13
                : 209
                Affiliations
                [1 ]Department of Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan Province, 610041, China
                Article
                1471-2474-13-209
                10.1186/1471-2474-13-209
                3487867
                23102117
                Copyright ©2012 Wang et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Research Article

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