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Congenital torticollis

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 10 Aug 2025
Last updated: 07 Apr 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
Full details

Other diagnostic factors

  • twin birth
  • unvaried supine sleep and resting position
  • decreased prone awake time
  • head tilt
  • head rotated with decreased active rotation to affected side
  • decreased head righting to contralateral side
  • sternocleidomastoid mass
  • ipsilateral shoulder elevation
  • plagiocephaly/craniofacial asymmetry
  • hypertropia on contralateral side
  • hip click or asymmetry
Full details

Risk factors

  • plagiocephaly
  • breech delivery
  • caesarean section delivery
  • twin A (lower in utero)
  • complicated deliveries (forceps or vacuum)
  • birth trauma
Full details

Diagnostic investigations

1st investigations to order

  • cervical spine x-ray
  • pelvic x-ray
  • hip ultrasound
Full details

Investigations to consider

  • neck ultrasound
  • skull x-ray
  • cervical/cranial MRI
Full details

Treatment algorithm

ONGOING

inadequate head control or age <5 months

good head control and age >5 months

Contributors

Authors

Joyce L. Oleszek, MD
Joyce L. Oleszek

Associate Professor

Department of Physical Medicine and Rehabilitation

University of Colorado School of Medicine and The Children's Hospital Colorado

Aurora

CO

Disclosures

JLO is co-author of one of the references cited in this topic.

Peer reviewers

Elizabeth A. Moberg-Wolff, MD

Associate Professor

Program Director

Tone Management and Mobility

Children's Hospital of Wisconsin

Milwaukee

WI

Disclosures

EAMW declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Cheng JC, Wong MW, Tang SP, et al. Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants. A prospective study of eight hundred and twenty-one cases. J Bone Joint Surg Am. 2001;83-A(5):679-87. Abstract

Cheng JC, Au AW. Infantile torticollis: a review of 624 cases. J Pediatr Orthop. 1994;14:802-808. Abstract

Binder H, Eng GD, Gaiser JF, et al. Congenital muscular torticollis: results of conservative management with long-term follow-up in 85 cases. Arch Phys Med Rehabil. 1987 Apr;68(4):222-5. Abstract

Positioning and sudden infant death syndrome (SIDS): update. American Academy of Pediatrics Task Force on Infant Positioning and SIDS. Pediatrics. 1996;98:1216-1218. Abstract

Emery C. The determinants of treatment duration for congenital muscular torticollis. Phys Ther. 1994 Oct;74(10):921-9.Full text  Abstract

Cheng JC, Tang SP, Chen TM, et al. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants - a study of 1,086 cases. J Pediatr Surg. 2000 Jul;35(7):1091-6. Abstract

Cheng JC, Tang SP. Outcome of surgical treatment of congenital muscular torticollis. Clin Orthop Relat Res. 1999 May;(362):190-200. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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