200 Section - The Role of Kinesiotaping in Atlantoaxial Rotatory Subluxation Associated with Nemaline Myopathy: A Case Report

Case Diagnosis: An 8-year-old female with a history of NM, characterized by early-onset hypotonia and delayed motor milestones, presented with progressive neck pain and torticollis (left rotation, right tilt) following a posterior pharyngeal flap procedure. A neck CT confirmed AARS, showing an atlantoaxial angle of 37 degrees and an asymmetric lateral atlantodental interval (LADI) discrepancy of 4.53 mm.

Case Description: Initial treatment consisted of Gardner-Wells–style tongs traction (10 lb) applied for 21 hours daily. However, due to significant axial hypotonia and ligamentous laxity, the patient experienced recurrent misalignment whenever traction was paused. Kinesiotaping was applied to the left sternocleidomastoid (SCM) muscle to facilitate its activation and restore muscular balance. Within five days of this combined approach, the LADI discrepancy improved to less than 2 mm. Over a 25-day period, her pain (VAS) decreased from 4 to 1, and midline alignment was successfully maintained.

Discussions: This case report describes a pediatric patient diagnosed with NM and AARS who did not respond sufficiently to traction alone but showed improvement when kinesiotaping was used in combination with Gardner-Wells–style tongs traction. Although definitive causality cannot be established, the findings of this case suggest that in patients with AARS who have muscle weakness or ligamentous laxity associated with neuromuscular conditions, kinesiotaping may have contributed to recovery by helping maintain the corrected cervical alignment during treatment.

Conclusions: This case study suggests that in patients with underlying hypotonia and muscle weakness, such as those with neuromuscular disorders, the addition of kinesiotaping to conventional treatments like traction or neck orthosis may have an additive effect.