Congenital torticollis is a neck deformity that involves shortening of the sternocleidomastoid (SCM) muscle resulting in limited neck rotation and lateral flexion.
Infants tilt their head toward the side of the shortened muscle and rotate to the contralateral side.
Plagiocephaly and craniofacial deformities can be associated with congenital muscular torticollis (CMT) and can perpetuate one another.
Developmental hip dysplasia can be associated with CMT.
It is important to rule out nonmuscular causes such as ocular, vertebral, and neurologic.
Treatment includes caregiver education on positioning and physical therapy; onabotulinumtoxinA injections or surgery are reserved for recalcitrant cases.
Congenital muscular torticollis (CMT) is a neck deformity that involves shortening of the sternocleidomastoid (SCM) muscle resulting in limited neck rotation and lateral flexion. This results in a head tilt to the affected side and rotation to the contralateral side.
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
- breech delivery
- cesarean section delivery
- twin A (lower in utero)
- complicated deliveries (forceps or vacuum)
- birth trauma
1st investigations to order
- cervical spine x-ray
- pelvic x-ray
- hip ultrasound
Investigations to consider
- neck ultrasound
- skull x-ray
- cervical/cranial MRI
inadequate head control or age <5 months
good head control and age >5 months
- Superior oblique palsy
- Central nervous system tumor
- Vertebral anomaly
- Physical therapy management of congenital muscular torticollis
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