Ortopedyczne postępowanie z kręczem - wersja angielska

Orthotic Management of Congential Muscular Torticollis
Presented By: Karl Fillauer, CPO, FAAOP; Fillauer, Inc
Robert R. Madigan, MD; Knoxville Orthopedic Clinic

What is Torticollis?

Torticollis is a condition where the head is bent to one side and rotated in the opposite direction due to acongenital shortening of the sternocleidomastoid muscle. This condition becomes apparent shortly after birth and is also known as “wr y neck” syndrome. The causes of torticollis may be genetic, acquired, or idiopathic (occurring without a known cause) and may also develop later in childhood or adulthood. Acquired torticollis, much more difficult to treat, results from damage to the muscular or ner vous system due to trauma or disease. In most cases surgical release of the tight sternocleidomastoid muscle is indicated followed by aggressive physical therapy to stretch the contracture. Often the surgeon is interested in orthotically managing the deformity by gradually moving the head into the correct position. The Fillauer Torticollis Orthosis has the advantage of being able to maintain the head in any position desired with respect to cer vical flexion, abduction, and transverse rotation.

Diagnosis - Data

• Muscular torticollis is a common congenital musculoskeletal anomaly after dislocated hip and clubfoot.
• Incidents var ying from 0.4% to 1.9%
• No predilection for either sex
• 6.% to 19.% (congenital Muscular Diagnosis 3-12 months) have incidence of hip dysplasia in direct relation to the severit y of the torticollis.

Types of Treatment

• Physical Therapy - Muscle Stretching, P. T. and Parents
• Surger y Followed with Physical Therapy and Orthosis.

Orthotic Indications and Goals

• Easy to Fabricate • Ease of Donning/Doffing
• Comfortable for patient • Positional Adjustments
• Physiological Positioning • Stabilit y

Recommended Success Factors

• Accurate Measurement and Cast
• Ease in Donning/Doffing and a Comfortable Fit
• Multiplane Positional Adjustments

Orthotic Design

• Height Adjustment
• • M-L Angulation Adjustment
• Rotational Adjustment
• A-P Placement
• Right or Left

Components

• Torticollis Joint (A Multiplane Adjustable Connector)
• Helmet/Shoulder Sections
• Elastic Velcro Straps

Materials

• Pe -Lite Interface 3mm
• Velcro Straps
• • Copolymer Thermoplastic 1/8 inch - Transfer Paper to Personalize

Measurements

Temporal Head A-P Temporal Head M-L Base of Neck to Mandible A-P Temporal Head Circumference
Patient Positioning
Stretch and exercise patient to obtain proper holding position during plaster impression.
Fillauer® P.O. Box 5189 • 2710 Amnicola Hwy • Chattanooga, TN 37406 • 800 251 6398 • Fax: 423 629 7936 • Web: www.fillauer.com/products/torticollis
Preparation for Plaster Impression
Plaster Splint of Head & Neck Impression
Preoperative - Fitting and Delivery
Postoperative Management

Apply 1st stockinette from base of neck to include shoulders
Apply 2nd stockinette over- lapping a minimum of 1 inch
Apply tape to secure stockinette
Plaster impression of left
Torticollis
Make needed multiplane adjustments
Confirm fit for contact at base of neck
Utilize elastic velcro for comfort and security

• Physician can easy adjust alignment and head position.
• Time of wear: three months full time, three months night wear.
• Stretching exercise performed by parents and therapist.
• Patient should be followed by Or thotist in addition to Physician during initial three months.

Verif y head position
Confirm proper fit
(lateral view)
Evaluate and adjust elastic strapping as needed

References

• Binder, H., Eng, G.D. Gaiser, J.F., Koch, B. Congenital Muscular torticollis. Arch Phys Med Rehabil 68:222-225, 1987
• Wolfort, F.G., Kanter, M.A., Miller, L.B. Torticollis. Plast. Reconstr. Surg Sept. 2, pp, 682- 692, 1988. M024/03- 01