1/15. Atlantoaxial rotary subluxation in children.Traumatic torticollis is an uncommon complaint in the emergency department (ED). One important cause in children is atlantoaxial rotary subluxation. Most children present with pain, torticollis ("cock-robin" position), and diminished range of motion. The onset is spontaneous and usually occurs following minor trauma. A thorough history and physical examination will eliminate the various causes of torticollis. Radiographic evaluation will demonstrate persistent asymmetry of the odontoid in its relationship to the atlas. Computed tomography, especially a dynamic study, may be needed to verify the subluxation. Treatment varies with severity and duration of the abnormality. For minor and acute cases, a soft cervical collar, rest, and analgesics may be sufficient. For more severe cases, the child may be placed on head halter traction, and for long-standing cases, halo traction or even surgical interventions may be indicated. We describe two patients with atlantoaxial rotary subluxation, who presented with torticollis, to illustrate recognition and management in the ED.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/15. Rotary atlanto-axial subluxation with torticollis following central-venous catheter insertion.Atlanto-axial subluxation with torticollis is an uncommon condition that occurs in children usually as a result of pharyngeal infection, minor trauma, or neck surgery. Passive motion of the head and neck during general anesthesia is probably another etiologic factor. torticollis is the most common presenting physical finding. Pain may or may not be present, but is commonly present with passive neck motion. Neurologic sequelae are uncommon. Our case illustrates this condition as a complication of central venous catheter (CVC) insertion in a child under general anesthesia. The surgeon should suspect this pathology when a child presents with torticollis following CVC placement. Precautions should be taken in the operating room to avoid aggressive rotation and extension of the child's neck while under general anesthesia whether or not cervical inflammation is present. Special attention to head and neck positioning should be taken in patients with Down's syndrome since they are at increased risk for atlanto-axial subluxation. The prognosis is excellent when diagnosed early. A delay in diagnosis can result in the need for surgical intervention.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
3/15. Effect of prolonged neck muscle vibration on lateral head tilt in severe spasmodic torticollis.Short term vibration of the dorsal neck muscles (10-35 s) is known to induce involuntary movements of the head in patients with spasmodic torticollis. To investigate whether neck muscle vibration might serve as a therapeutic tool when applied for a longer time interval, we compared a vibration interval of 5 seconds with a 15 minute interval in a patient with spasmodic torticollis with an extreme head tilt to the right shoulder. head position was recorded with a two camera optoelectronic motion analyzer in six different test conditions. vibration regularly induced a rapid change of head position that was markedly closer to a normal, upright posture. After 5 seconds of vibration, head position very quickly returned to the initial position within seconds. During the 15 minute interval, head position remained elevated. After terminating vibration in this condition, the corrected head position remained stable at first and then decreased slowly within minutes to the initial tilted position. CONCLUSIONS: (1) In this patient, muscle vibration was the specific sensory input that induced lengthening of the dystonic neck muscles. Neither haptic stimulation nor transcutaneous electrical stimulation had more than a marginal effect. (2) The marked difference in the change of head position after short and prolonged stimulation supports the hypothesis that spasmodic torticollis might result from a disturbance of the central processing of the afferent input conveying head position information-at least in those patients who are sensitive to sensory stimulation in the neck region. (3) Long term neck muscle vibration may provide a convenient non-invasive method for treating spasmodic torticollis at the central level by influencing the neural control of head on trunk position.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/15. Nontraumatic atlantoaxial rotary subluxation in the pediatric otolaryngology patient. A report of four cases.Nontraumatic atlantoaxial rotary subluxation (NAARS) is a relatively uncommon entity, with inconsistent presentations. It most commonly follows infectious processes or operative procedures. We present our experience with 4 pediatric otolaryngology patients with NAARS who were treated at the University of iowa hospitals and Clinics during a 2-year period beginning in 1997. A review of the symptoms, physical findings, and radiographic abnormalities is presented. Treatment options, varying from muscle relaxants to surgical fusion, are discussed. A high index of suspicion in evaluating children with a stiff neck or pain on attempted motion is essential in order to facilitate prompt diagnosis and appropriate intervention.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/15. Atlantoaxial rotatory fixation secondary to tuberculosis of occiput: a case report.STUDY DESIGN: A case of nontraumatic rotatory fixation of the atlantoaxial joint associated with tuberculosis of the occipital bone in an adult. OBJECTIVES: To report a rare case of atlantoaxial rotatory subluxation associated with tuberculosis of the occipital bone in an adult and to discuss the mechanism of fixation. SUMMARY OF THE BACKGROUND DATA: Atlantoaxial rotatory fixation in adults is rare and has been reported due to variety of causes. To the authors' best knowledge no case has been reported secondary to tuberculosis of the skull bone. methods: A 20-year-old male presented with resistant torticollis with a duration of 5 months. RESULTS: The patient had type 1 atlantoaxial rotatory fixation secondary to tuberculosis of the occipital bone. The subluxation was partially reduced by conservative means, and healing of the occiput lesion was achieved. Thereafter, the patient had no restriction of cervical spine motion and had no reoccurrence of subluxation at a follow-up of one and a half years. CONCLUSIONS: Effusion in the atlantoaxial joint secondary to infection in the occiput due to close proximity with the joint led to the laxity of ligaments and contributed to the subluxation.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/15. Botulinum toxin enhancement of postoperative immobilization in patients with cervical dystonia. Technical note.Postoperative immobilization in patients with cervical dystonia requiring fusion presents a unique management problem. Two patients with severe degenerative cervical spine disease secondary to chronic repetitive motion are reported. Both required a surgical fusion and postoperative immobilization. Botulinum toxin was injected intramuscularly to assist in immobilization. The technique used is described.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/15. Automated assessment of cervical dystonia.We developed an automated and objective method to measure posture and voluntary movements in patients with cervical dystonia using Fastrack, an electromagnetic system consisting of a stationary transmitter station and four sensors. The junction lines between the sensors attached to the head produced geometrical figures on which the corresponding aspects of the head were superimposed. The head position in the space was reconstructed and observed from axial, sagittal, and coronal planes. Four patients with cervical dystonia and 6 healthy subjects were studied. Each patient was representative of one of the typical patterns of cervical dystonia. The study allowed the authors to collect quantitative data on posture and range of motion of the head. This pilot study demonstrates the efficacy of the Fastrack system to objectively measure the head position in cervical dystonia patients.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/15. Treatment of cervical dystonia and focal hand dystonia by high cervical continuously infused intrathecal baclofen: a report of 2 cases.We describe 2 patients, one with cervical dystonia (CD) combined with focal hand dystonia (writer's cramp) and another with idiopathic CD, who were unresponsive to oral medications and became resistant to botulinum toxin type A and B injections. Both patients were successfully treated with high cervical (C1-3) continuously infused intrathecal baclofen (ITB). Neck range of motion (ROM) was measured by using a 3-dimensional electromagnetic cervical ROM system. Pain, disability, and severity were assessed by using the Toronto Western Spasmodic torticollis Rating Scale (TWSTRS). The patient with CD and writer's cramp did well on a continuous baclofen dose of 186.1 microg/d. Her total TWSTRS score improved significantly, her electromagnetic measurements showed an increased in total neck flexion and extension, and her handwriting improved. Unfortunately, this patient (a heavy smoker) developed small cell carcinoma of the lung and died 9 months after her pump was placed. Total TWSTRS score and electromagnetic measurements also significantly improved after pump implant in the patient with CD. He continues to do well on a periodic bolus dose using a combination of 50 microg of baclofen and 25 microg of hydromorphone (Dilaudid) every 4 hours. Our findings suggest the potential usefulness of this therapy in other patients with focal dystonia. To our knowledge, this is the first reported successful treatment of CD and CD combined with writer's cramp with high cervical continuously infused ITB.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/15. Successful reduction for a pediatric chronic atlantoaxial rotatory fixation (Grisel syndrome) with long-term halter traction: case report.STUDY DESIGN: Clinical case report of atlantoaxial rotatory fixation (AARF) in a girl presenting with torticollis and neck pain. OBJECTIVE: To report this rare case that was successfully treated with long-term traction and a brace. SUMMARY OF BACKGROUND DATA: AARF is a rare kind of subluxation that is a pathologic fixation of the atlas on the axis. It is most common in pediatric patients and is usually reduced easily with conservative treatments only in the acute stage. However, previously reported chronic AARFs have usually been treated with operative reductions. Although high success rates have been achieved with operative reduction in chronic cases of AARF, even successful operative reduction may result in significant neck motion limitation. methods: A 9-year-old girl had torticollis of more than 3 months duration develop as a result of an upper respiratory infection. Dynamic computerized tomography showed consistent fixation of the atlantoaxial joint consistent with type 1 AARF according to the classification of Li and Pang. The patient was treated with halter traction of 5-lb weight for 6 weeks, and with a brace for 4 months and collar for 2 months. RESULTS: We successfully treated this patient with chronic AARF only with cervical traction. She had full recovery of neck motion and normal atlantoaxial angle on follow-up computerized tomography after 6 months. CONCLUSION: From this case, we suggest that long-term traction could be another treatment method for chronic AARF, especially in children.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
10/15. TAMO therapy as a major component of physical therapy intervention for an infant with congenital muscular torticollis: a case report.PURPOSE: Tscharnuter Akademie for Motor Organization (TAMO) therapy is a therapeutic approach based on dynamic theories of motor control. research evidence supporting this approach is limited. The purpose of this case report is to describe the use of TAMO therapy in the physical therapy intervention for an infant with congenital muscular torticollis (CMT). The patient was a 4.5-month-old baby boy (corrected age) with left CMT. methods: Intervention included TAMO therapy, active range of motion exercise, soft tissue mobilization, and parent instruction. Changes in the amount of lateral head tilt were documented using still photography RESULTS: The infant assumed a midline head position in the supine position by the second weekly visit and maintained a midline head alignment during all functional activities by the eighth visit. CONCLUSION: This case report is the first attempt to describe a successful application of TAMO therapy as a major component of physical therapy intervention for an infant with CMT.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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