Digital Analysis of Ultrasonographic Images in Children With Wry Neck

Detailed Summary

Torticollis is a clinical sign or symptom that could be the result of a variety of underlying disorders. Among the etiologies, Congenital muscular torticollis (CMT) with impairment of the sternocleidomastoid (SCM) is the most frequent cause of torticollis in infants. CMT is a postural deformity detected at birth or shortly after birth, primarily resulting from unilateral shortening and fibrosis of the SCM. Infants with CMT display head tilt to one side, which is often combined with rotation of the head to the opposite side. In 2002, Chih-Chin Hsu et al. reported that CMT could be classified into four types. The majority of Type I and II fibrosis improved after conservative treatment. However, Type III and Type IV had more probability in need of surgical correction. However, this categorization lacks of objective and quantitative measurement and can be different by subjective judgement of different physicians. The purpose of this study is tried to perform digital analysis of ultrasonography images to establish an objective, quantitative method and to assess its relevance with clinical symptoms and prognosis. This study will collect the children younger than one year-old who were impressed or suspected to have torticollis in physical medicine and rehabilitation clinic to assess the relationship between digitalization results of ultrasound image and clinical manifestations and prognosis. Digital image analysis of ultrasound which contains both sides of the SCM in transverse and longitudinal view for comparison of lesion side and sound side will be performed after the initial enrollment and every six months later. Evaluation of clinical manifestations includes measurement of side difference of angles in bilateral neck lateral flexion, rotation and habitual head position will performed using an arthrodial protractor by a trained member at the beginning of physical therapy and one month later, then every 2-3 months. All cases will be followed for 1 and a half years. We expect to find some typical characteristics of CMT through digital analysis of the SCM. These characteristics include the muscle thickness and intensity of echogenicity in the region of interest. The Pearson's correlation will be performed to analyze the relevance of quantitative side differences in ultrasonography and clinical manifestations including side differences of neck rotation, lateral flexion and habitual head position between lesion sides and sound sides.

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