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Course: Pediatric Nursing

Topic: Nursing Care of Child with Musculoskeletal Disorders Part II

The Nurses International Community

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Module Goals

Learners will be able to:

Define torticollis, polydactyly and syndactyly
List out the causes of these disorders
Discuss the symptoms of torticollis, polydactyly and syndactyly
Describe common diagnostic procedures for these disorders
Describe common medical treatments for these disorders
Discuss the nursing management of a child with these disorders

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Torticollis (Wry Neck)

Baby’s head is held tipped to one side with the chin rotated toward the other
Occurrence same in boys and girls

Government of Western Australia Child and Adolescents Health Service, 2021

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Torticollis (Wry Neck): Congenital

Muscular torticollis

Due to fibrosis and shortening of one of the sternocleidomastoid muscles

Caused by abnormal intrauterine positioning of the head or birth trauma

Congenital vertebral abnormalities

Congenital torticollis are caused by a bone problem in the neck portion of the spine (cervical spine)

Government of Western Australia Child and Adolescents Health Service, 2021

British Columbia,2021

Contact info: info@nursesinternational.org

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Torticollis (Wry Neck): Acquired

Occurs later in life
Caused by minor muscle trauma and spasm secondary to a nearby inflammatory process:

Upper respiratory tract infection
Cervical lymphadenitis, dental abscess, retropharyngeal abscess, or upper lobe pneumonia
A tumour of the posterior fossa or spinal cord (uncommon)

Government of Western Australia Child and Adolescents Health Service, 2021

Contact info: info@nursesinternational.org

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Torticollis (Wry Neck): Symptoms

Tilting of head to one side
Turning of chin toward the opposite side of the head
Difficulty moving the head
Firm, small, lump in the middle of the neck muscle

British Columbia, 2021

Stanford Children’s Hospital, 2022

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Torticollis (Wry Neck): Symptoms (Continued)

In severe cases:

Flattening of the side of the head
Differences between the sides of the face
Oddly positioned ear
Other abnormalities of muscles, bones, and joints

British Columbia, 2021

Stanford Children’s Hospital, 2022

Contact info: info@nursesinternational.org

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Critical Thinking Question

What are the symptoms present in a child with Wry Neck? (Select all that apply)

Tilting of head to one side
Turning of chin toward the opposite side of the head
Difficulty moving the head
Lump in the middle of the neck muscle

Contact info: info@nursesinternational.org

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Torticollis (Wry Neck): Diagnosis

Physical examination
Cervical X-rays
Electromyogram
Ultrasound exam
CT scan and MRI

British Columbia, 2021

Stanford Children’s Hospital, 2022

Contact info: info@nursesinternational.org

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Torticollis (Wry Neck): Treatment

Physiotherapy, Gentle stretching
During feeding, hold the child in a way that makes them rotate the chin to the correct position
Place the crib so that the child turns their chin the correct way in order to see the room
Place toys in such a way that the infant has to turn their head to see them and play with them
Surgery (Rare): to correct the muscle

British Columbia, 2021

Stanford Children’s Hospital, 2022

Contact info: info@nursesinternational.org

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Torticollis (Wry Neck): Nurses Role

Performs Passive stretching exercises
Encouraging the infant to look at the affected muscle (by feeding toward the direction of the affected area and positioning mobiles)
Teach parents:

Place the crib so that the child turns their chin the correct way in order to see the room
Place toys in such a way that the infant has to turn their head to see them and play with them

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Critical Thinking Question

What are the treatment options for Torticollis? (Select all that apply)

Physical therapy
Surgery
Passive stretching exercises
Medications

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Polydactyly

Cedars Sinai, 2022

A condition in which an extra finger or toe is present on the hand or foot
Usually affects only one hand or foot rather than both
Often runs in families

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Polydactyly: Types

Three types:

Pre-axial polydactyly: the extra digit located outside the thumb (radial polydactyly).
Post-axial polydactyly: the extra digit located outside the little finger (ulnar polydactyly).
Central polydactyly: the extra digit located in between other fingers or toes.

Cedars Sinai, 2022

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Polydactyly: Causes

Isolated polydactyly most often passed from a parent to a child through genes

Gene GLI3

Associated with other syndrome:

Diamond-Blackfan anemia, Fanconi anemia
Ellis-van Creveld syndrome
VACTERL (vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities)
Trisomy 13

Al Amin & Carter, 2022

Hecht, 2019

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Polydactyly: Symptoms

Extra fingers or toes on one or both of their hands or feet

The extra digit or digits may be:

Complete and fully functional
Partially formed, with some bone
Only a small mass of soft tissue (called a nubbin)

Hecht, 2019

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Critical Thinking Question

Polydactyly usually affects one hand or foot rather than both.

True
False

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Polydactyly: Treatment

Surgery is usually recommended

Varies from a minor procedure in the clinic to more involved reconstructive surgery

Hecht, 2019

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Syndactyly

Webbing or fusing between fingers or toes.
Partially fused or fused along entire length.
Commonly occurs between middle two fingers.
Severity range from simple fusion connected only by skin to more complicated fusion with shared nerves, blood vessels, bones, and/or nails.

Birth Defect Research for Children, n.d

Children Hospital of Philadelphia, n.d

Contact info: info@nursesinternational.org

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Syndactyly: Causes

Heredity
An infant’s fingers and toes separate during the sixth to eighth week of development
Occurs when the digits fail to fully separate into individual fingers and toes
In rare cases, associated with other genetic abnormalities and syndromes:

Poland syndrome, Apert syndrome and Carpenter syndrome

Birth Defect Research for Children, n.d

Children Hospital of Philadelphia, n.d

Contact info: info@nursesinternational.org

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Syndactyly: Diagnosis and Treatment

Medical history
Physical examination
X -rays
Genetic testing and imaging of other parts of the body to find associated genetic syndrome

Surgery to separate the fingers or toes

Birth Defect Research for Children, n.d

Children Hospital of Philadelphia, n.d

Contact info: info@nursesinternational.org

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Syndactyly: Nurses Role

History
Physical examination
Psychological support
Health education:

About the disease and its treatment

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Critical Thinking Question

The common treatment for polydactyly and Syndactyly is________.

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

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References:

Al Amin, A.S.M., & Carter, K.R. (2022). Polydactyly. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562295/

Birth Defects Research for Children. (n.d).Syndactyly and Polydactyly. https://birthdefects.org/syndactyly-and-polydactyly/

British Columbia. (2021). Congenital Torticollis. https://www.healthlinkbc.ca/health-topics/congenital-torticollis

Cedars Sinai. (2022). Polydactyly. https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/polydactyly.html

Children Hospital of Philadelphia. (n.d). Syndactyly. https://www.chop.edu/conditions-diseases/syndactyly

Contact info: info@nursesinternational.org

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References:

Government of Western Australia Child and Adolescents Health Service. (2021). Torticollis. https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Torticollis

Hecht, M. (2019). What Is Polydactyly?. [(Review of article, ‘What is Polydactyly?’ by,M. William ]. Healthline. https://www.healthline.com/health/polydactyly

Stanford Children Hospital. (2022).Congenital Muscular Torticollis. https://www.stanfordchildrens.org/en/topic/default?id=congenital-muscular-torticollis-90-P02070

Stanford Children’s Health. (2022). Polydactyly (Extra Fingers). https://www.stanfordchildrens.org/en/service/hand-upper-limb-surgery/polydactyly

Contact info: info@nursesinternational.org

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