Congenital muscular wryneck – one of kinds of a wryneck, group of the states which are characterized by change of normal position of the head. The congenital muscular wryneck begins to be shown with the 2-3rd week of life of the child by the accruing thickening of a kivatelny muscle. At a unilateral wryneck the head bends in the sick party and is a little developed in the healthy party by the person. At a bilateral wryneck (meets less often) the head of the patient deviates back. Treatment of a congenital muscular wryneck is carried out by the orthopedist. From conservative techniques massage, LFK, physiotreatment, according to indications - carrying a collar of Shants is actively applied. Surgical treatment consists in lengthening - a clavicular and mastoidal muscle on the party of defeat.
Congenital muscular wryneck
Congenital muscular wryneck – one of kinds of a wryneck, group of the states which are characterized by change of normal position of the head. At a wryneck the head bends in the sick party and is a little developed in the healthy party by the person. At a bilateral wryneck (meets less often) the head of the patient deviates back.
The congenital muscular wryneck is congenital pathology, the third on prevalence, makes 5-12% of total number of malformations, meets at girls more often.
Types of a wryneck
The deformations of a neck arising for various reasons united by one sign – violation of position of the head belong to a wryneck. The orthopedics and traumatology allocate two big groups of wrynecks: congenital and acquired. The most widespread type of congenital violation is a congenital muscular wryneck. Except pathology of muscles, the wedge-shaped neck, cervical edges, unions and other malformations of cervical vertebras can become the cause of a congenital wryneck. Development of the acquired wryneck happens at increase in a tone of cervical or okolopozvonochny muscles, damages of cervical department at a spine injury, profound cicatricial changes of area of a neck, inflammatory diseases of parotid gland (parotitis), a middle ear (otitis) and soft fabrics of area of a neck.
In a neck there is a large number of the muscles participating in the movements and formation of position of the head including – and steam rooms - clavicular and mastoidal (kivatelny) muscles which fasten the one end to a mastoidal shoot of a temporal bone, and to others – to a breast and a clavicle.
The congenital muscular wryneck arises owing to shortening of a kivatelny muscle on the party of defeat. Change of length of a muscle can be caused by its underdevelopment, a patrimonial trauma and some other factors. Shortening of a kivatelny muscle causes not only change of position of the head. At the child suffering from a congenital muscular wryneck changes of a skull, clavicles and a backbone develop.
Main reasons for a congenital muscular wryneck:
- underdevelopment of a kivatelny muscle;
- the rupture of fibers of a muscle caused by a patrimonial trauma;
- chronic inflammation of a muscle;
- insufficient blood supply of a muscle.
Besides, the congenital muscular wryneck can develop as a result of the long inclined provision of a fruit at which favorable conditions for shortening of a kivatelny muscle are created.
The child's head with a congenital muscular wryneck is inclined in the struck party and it is a little forward, the person is moderate or insignificant in detail in the healthy party. By Nadplechye on the party of defeat it is lifted, asymmetry of a skull and person is observed. At survey cervical scoliosis, asymmetry of a neck and head behind comes to light. For diagnostics of changes from a backbone carry out a X-ray analysis. In certain cases a muscular wryneck backbone MRT can be required. All changes are secondary, develop because the organism of the child tries to adapt to pathological position of a neck, and disappear after treatment of a congenital muscular wryneck.
As a rule, the congenital muscular wryneck is imperceptible in the first ten days of life of the child. For 15-20 day the thickening and consolidation in a middle or srednenizhny part of a kivatelny muscle appears. Changes gradually accrue. Together with progressing of changes become more and more expressed manifestations of a congenital muscular wryneck.
Some patients aged from 2 months till 1 year have a consolidation and a thickening of a kivatelny muscle disappears independently, and the muscle becomes elastic again. At other patients pathology continues to progress, elasticity of a muscle decreases, the muscle is condensed, becomes thinner and lags behind in growth in comparison with a muscle on the opposite side.
Pathological changes in a muscle become a cause of infringement of local exchange processes, and exchange violations, in turn, cause further aggravation of a wryneck. The peculiar closed vicious circle is formed, and by 3-6 years of life of the child deformation of a neck becomes even more expressed.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Treatment is performed by the orthopedist. In the course of treatment conservative and operational techniques can be used. The choice of a method of treatment depends on age of the child, a condition of a kivatelny muscle and extent of deformation of a neck. The early initiation of treatment of a congenital muscular wryneck allows to eliminate completely pathology, without resorting to operation. In the absence of treatment at the child with a congenital muscular wryneck asymmetry of a skull is gradually formed, and with age treatment becomes less effective.
Conservative therapy of a congenital muscular wryneck is begun in maternity hospital. The child is stacked in a special way (on a healthy side), fed so that he tried to turn a head in the struck party, appoint massage of kivatelny muscles.
Treatment continues also after an extract from maternity hospital. To the kid appoint special remedial gymnastics, carry out massage. The affected muscle is warmed up a lamp of "Sollyuks" or a hot-water bottle. After to the child 1,5-2 months to the list of medical actions it will be executed the electrophoresis with iodide potassium is added. Carrying a special cap or Shants's collar is shown to some children.
The correct care of the child is of great importance. The kid cannot be held before the put term vertically. When laying in a bed of the child it is necessary to hold a head in the correct situation (various bandages special of a cap, sacks with sand etc. are used). At the timely beginning of complex treatment in most cases it is possible to achieve full elimination of a wryneck before the child is 5-6 months old.
The indication to expeditious treatment is preservation of the expressed wryneck at the child aged 2 years are more senior. It is better to perform operation after the patient is 3 years old. Surgical treatment consists in lengthening - a clavicular and mastoidal muscle on the party of defeat. In the postoperative period to the patient apply a plaster bandage for a period of up to 1,5 months. Within half a year after operation carrying a special headholder, physiotherapeutic procedure and physiotherapy exercises is shown to the patient.