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CURRENT ESSENTIALS PEDIATRICS - part 7

Sự co cơ đơn phương sternocleidomastoid trong những nguyên nhân cằm để xoay ra khỏi sự co và đầu nghiêng Hướng tới các sự co nguyên nhân, bệnh của cột sống cổ tử cung, gây thương tích cho sternocleidomastoid các TRONG giao hàng, hoặc áp lực trong tử cung sternocleidomastoid IS thường sờ thấy khối lượng. | Chapter 18 Orthopedics 311 Torticollis Essentials of Diagnosis Unilateral contracture of the sternocleidomastoid muscle causes the chin to rotate away from the contracture and the head to tilt toward the contracture Causes diseases of the cervical spine injury to the sternocleidomastoid during delivery or intrauterine pressure Sternocleidomastoid mass is often palpable. It is a fibrous transformation within the muscle not tumor Hip dysplasia associated in 20 of cases Diagnosis is by physical examination but magnetic resonance imaging MRI may be needed to completely evaluate Differential Diagnosis Arthrogryposis Klippel-Feil syndrome Cervical spine tumor or syrinx Brain tumor Rheumatoid arthritis older children Trauma and mild respiratory illness may precede onset Unilateral flattened occiput from intrauterine pressure or back sleeping causes apparent torticollis when infant is supine Motor weakness cerebral palsy dystonia spasticity produce torticollis Treatment Passive stretching is usually effective 1 year Surgical release after 1 year is effective in uncomplicated cases Excision of the fibrous tumor is unnecessary Qặ Pearl Infants with gastroesophageal reflux may assume a position of comfort known as Sandifer syndrome with neck extended and head tilted. Give an acid blocker to healthy children with torticollis to see if Sandifer syndrome is the cause. 312 Current Essentials Pediatrics Arthrogryposis Multiplex Congenita Essentials of Diagnosis Congenital fibrous ankylosis of many joints shoulders adducted elbows extended wrists flexed fingers stiff dislocated hips knees extended club feet scoliosis Usually bilateral involvement Infants usually have normal mental and sensory development but severe physical disability Variable inheritance may be associated with other somatic abnormalities Diagnosable by intrauterine ultrasound Differential Diagnosis Intrauterine pressure with unilateral decrease in fetal limb movement causes joint contractures In utero .