Clinical Skills (Congenital Muscular Torticollis)

Figure scha_8a_n.jpg: Position of an infant for palpation and functional testing of the sternocleidomastoid muscles. The head is movable and lies in the hands of the examiner while the mother has contact with the infant and holds the shoulders in a correct supine position. The muscles are palpated simultaneously, and a diffuse or localized induration = fibrosis is looked for. Figure scha_8b_n.jpg: Instead of testing a possible constricted sideward inclination as quantification of restriction of motion a determination of the possible rotation of the involved side in comparison to the normal side is a better tool. The normal rotation of the head amounts for both sides to 80 to 90 degrees down to the surface of the bed. The initial value is a good measure for the severity of torticollis and is everytime reproducible; therefore, the natural history and a possible benefit of therapy can be quantitatively tested. To the clinical skills also comprise the inspection of the head $$kran_2??(see alternate figures), of the neck, and of the thorax from the front and from behind.