- spasmodic, unilateral contraction of neck muscles
- due to birth trauma or in utero position
- may be associated with other orthopedic or neurologic anomalies
- in older kidz; if torticollis vanishes when patient's eyes are covered,
or when changing from sitting to supine, ocular torticollis is likely (EOM
imbalance) vs orthopedic torticollis (SCM muscle imbalance)
- #1 cause of torticollis in childhood: fibrous dysplasia of the
- Not usually seen in nbn period, but hematoma may be palpated after birth
- firm, immobile, fibrous mass olive-sized mass or tightness in mid-SCM (usually on R side) at 2 weeks of age, reaches
maximal size @ 1 m/o, disappears by 4-6 mos;
- In relation to the affected side: will see head turned toward, chin
- there may be slight facial assymetry
- Examine the back for scapular size and mobility, since there is an
association of torticollis with Sprengelís deformity.
Histologically: dense fibrous tissue; may represent prenatal venous
obstruction and muscle damage to SCM
Differential Dx and workup
- Other conditions that usually occur later in
- inflammatory/infectious conditions of head/neck/OP
- atlantoaxial rotay subluxation.
- Consider other etiologies, e.g.,hemivertebrae, eye problems
- 8-20% association of congenital muscular torticollis with
DDH, so focus on hip exam and consider a
hip ultrasound or XR depending on
age of child
Treatment for congenital torticollis
- passive stretching exercises by extending the neck and head over a table
or motherís knee approximately 20 times, three times daily.
- positioning child's crib so that external stimuli cause child to turn head
and neck away from the side of the deformity.
- If the problem does not resolve by age 6-12 months, the patient should be
referred to Ortho.
- The deformity must be corrected
before the ocular righting reflex is developed, between ages 5 to 6, or
the child may not be able to maintain the correction because holding the head
level may interfere with vision.
CHLA Board Review 2005