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Congenital torticollis

Last reviewed: 29 Oct 2023
Last updated: 07 Apr 2022



History and exam

Other diagnostic factors

  • twin birth
  • unnvaried 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
Other diagnostic factors

Risk factors

  • plagiocephaly
  • breech delivery
  • cesarean section delivery
  • twin A (lower in utero)
  • complicated deliveries (forceps or vacuum)
  • birth trauma
More risk factors

Diagnostic investigations

1st investigations to order

  • cervical spine x-ray
  • pelvic x-ray
  • hip ultrasound
More 1st investigations to order

Investigations to consider

  • neck ultrasound
  • skull x-ray
  • cervical/cranial MRI
More investigations to consider

Treatment algorithm


inadequate head control or age <5 months

good head control and age >5 months



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




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




EAMW declares that she has no competing interests.

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