Correlation of clinical and ultrasonographic features in congenital muscular torticollis

Objective: To find the relationship between the ultrasonographic pictures and the clinical features of patients with congenital muscular torticollis (CMT). Design: Prospective survey of patients with clinically suspected CMT by high-resolution ultrasonography. Setting: Rehabilitation department of a tertiary care center. Participants: Two hundred fifty-six CMT patients, from the ages of 9 days to 16yrs, with a mean follow-up period of 6.7 months. Main Outcome Measures: Correlation of the ultrasound appearance of the involved sternocleidomastoid (SCM) muscles with clinical features. The pathologic findings in diseased muscles from patients who underwent surgical intervention were also evaluated. Results: Muscle abnormalities were identified ultrasonographically in 218 CMT patients (85%) and were classified into four types: a fibrotic mass in the involved muscle (type I, 15%); diffuse fibrosis mixing with normal muscle (type II, 77%) and without normal muscle in the involved muscle (type III, 5%); and a fibrotic cord in the involved muscle (type IV, 3%). Compared with type I patients, type IV patients were more likely to undergo surgical treatment (odds ratio = 31.54, p=.0196), Type III patients were more likely to undergo surgical treatment, although this tendency was not statistically significant. Conclusion: Ultrasonography can precisely identify pathologic changes in the involved SCM muscle of CMT patients, Type III and IV patients are more likely to require surgical intervention. (C) 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.