Thank you to all who responded. After some reading and extensive discussion
with the pediatric neurosurgeon at my hospital, I came up with some answers
to my questions. For those of you interested, here is what I have found:
If the chin points away from the SCM in spasm, it is usually torticollis,
especially in the setting of no trauma. Can get a muscle relaxer in the ED
and home with NSAIDS and a soft collar (for comfort) with follow-up for
re-evaluation in 5 days if no improvement. Chin in this direction, however,
does not exclude subluxation. If there is a history of trauma then imaging
may be indicated. If mild trauma, can probably get plain films and DC if
normal with therapy as above (some may still choose no imaging, though,
depending on how minor the trauma). If significant trauma, may as well go
right to CT.
Chin pointing toward the SCM in spasm is rotary subluxation. You can
probably go right to CT unless there is another reason to obtain a cspine
Comments? Anyone interested in a prospective multicenter study? Please
respond to me if so...
Thanks for your time!
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