Pediatric myotonic squint, commonly known as “crooked neck”, is a condition characterized by a child’s head tilted to the affected side and face rotated to the healthy side. Clinically, except for a very few cases caused by spinal deformity, visual impairment and neck muscle paralysis, myotonic squint is usually caused by contracture of the sternocleidomastoid muscle on one side. This disease is mostly caused by the injury and bleeding of one side of the sternocleidomastoid muscle due to the extrusion of the birth canal or forceps during delivery, and the contracture is formed by the mechanization of the hematoma; or the ischemic change of the muscle caused by the obstruction of blood flow due to the malposition of the fetus’ head during delivery, which causes edema, degeneration and hyperplasia of the muscle fibers, and finally causes muscle contracture, resulting in myotonic squint; or the ischemic change of the muscle caused by the obstruction of blood supply to one side of the sternocleidomastoid muscle due to the tilting of the fetus’ head to one side in utero. The ischemic change of the muscle is caused by the head tilting to one side in the womb. This disease belongs to the category of “tendon knot” and “tendon contracture” in Chinese medicine.
Clinical manifestations
(1) After birth, a lump may appear on one side of the neck in the form of an oval or striped mass, mostly confined to the middle and lower part of the sternocleidomastoid muscle, and later the sternocleidomastoid muscle on the affected side becomes contracted and tense.
(2) The child’s head is skewed to the affected side while the face is rotated to the healthy side, and the head and neck rotation is limited.
(3) In long-standing cases, the development of the affected side of the face is affected and is significantly smaller than that of the healthy side.
(4) Late stage may be accompanied by compensatory scoliosis of the thoracic spine.
(5) In early stage, there is no abnormal change in cervical spine X-ray examination, but in late stage, cervical scoliosis deformity may appear.
Massage treatment
(1) Treatment principle: relaxing tendons and activating blood, softening hardness and dispersing knots.
(2) Treatment steps
①Press and knead the affected sternocleidomastoid muscle and mass: the child lies on his side or supine, the doctor sits on the healthy side, press and knead the affected sternocleidomastoid muscle and mass for 5 to 10 minutes. The movements should be gentle.
②Knead the sternocleidomastoid muscle on the affected side: repeatedly knead the sternocleidomastoid muscle from top to bottom for 3 to 5 minutes. The force should be light and deep.
③Passive exercise: with the passive movement of the neck, mainly lateral bending to the healthy side and rotation of the affected side, repeatedly several times. The movement should be slow.
④Wipe the sternocleidomastoid muscle on the affected side: apply pressure with the thumb and push and wipe the sternocleidomastoid muscle on the affected side from top to bottom 20 times.
⑤ Pushing and rubbing Fengchi: Apply pressure with the ribbed side of the thumb and push and rub the Fengchi point on the affected side of the child for 1 minute.
(6) Take the shoulder well: use the thumb and the other four fingers to pinch the shoulder well point and the surrounding large tendons in the center of the line between the root of the child’s neck and the shoulder peak with relative force for 5 times.
(3) Course of treatment: The earlier the treatment, the better the effect. Generally within 3 months of the child’s birth is better to start massage, massage once a day, the course of treatment is longer, it takes 2 ~ 3 months.
【Caution】
(1) When distinguished from bony squint, postural squint and neurological squint.
(2) Timely detection and treatment. Generally, it is better to start treatment within 3 months of birth. When the mass disappears, pushing should be continued until the neck movement is normal.
(3) For long duration of the disease, if the treatment by massage is ineffective for more than six months, surgery can be considered for correction.