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 16 yrs, 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.