Factors influencing and long‑term effects of manual myotomy phenomenon during physiotherapy for congenital muscular torticollis

Zhenhui Zhao1†, Hansheng Deng1†, Xin Qiu1†, Gen Tang1†, Huijia Zheng2, Fang Yang3, Futang Gao4, Zhengyu Wu5, Yuanheng Li6, Shuaidan Zeng1, Jiaxin Zhao7, Yiyuan Sun1, Ziheng Zhou1, Yu Tang1, Zhiwen Cui1, Weiqing Li1, Xiaodi Chen1, Ting Cai1, Xian Liu1, Shicheng Li1*, Qisong Yang2*, Shengping Tang1* and Zhu Xiong8*

Purpose: To investigate the factors influencing and long-term effects of manual myotomy (MM) occurring during physiotherapy for congenital muscular torticollis (CMT).

Methods: We retrospectively collected the clinical data of children with CMT receiving physiotherapy between 2008 and 2018. The children were divided into manual myotomy (MM) and non-manual myotomy (NMM) groups according to whether MM occurred during treatment. We assessed physiotherapy outcomes in children with CMT using craniofacial asymmetry parameters and the Cheng–Tang rating score. By measuring the ear-eye distance, ear-nose distance, eye-mouth distance, ear-mouth distance, half-head circumference, and half-head top at two sides to evaluate
craniofacial asymmetry. Based on the Cheng–Tang assessment criteria, we recorded the range of rotation, range of lateral flexion, the status of the contracted muscle, the hardness of the mass, the extent of head tilting during activities and sleeping, the status of daily activities, face size, type of head shape, cranial changes, and subjective head tilting to assess the effectiveness of treatment. Clinical data and outcome indicators (craniofacial asymmetry parameters and Cheng–Tang rating score) were compared.

Conclusion: MM may occur during physical therapy for infants with CMT, especially for newborns. It is a clinical phenomenon that occurs during physiotherapy, not an adverse event that may lead to a poor outcome. It is more likely to occur in younger children, those with a larger SCM mass, and with DDH. Physiotherapists should consider the definition and tetrad signs of MM, and carefully control the stretch strength to ensure effective treatment and also avoid severe complications. Children with MM generally have a good prognosis. However, we do not recommend MM as a goal of treatment. In clinical practice, physiotherapists should investigate relevant factors in advance to predict the possibility of MM, and take preventive measures to avoid possible complications.