Congenital Muscular Torticollis

CONGENITAL MUSCULAR TORTICOLLIS

• Usually caused by contracture of the sternocleidomastoid muscle
• Usually occurs in infants.
• It’s a common neck problem in childhood
• Cause is unknown – May be caused form pressure on the muscle or compartment syndrome of the muscle.
• Child holds the head towards the affected side with the chin rotated towards the opposite side
• Difficulty in turning the head due to a tight and shortened sternocleidomastoid muscle.
• Usually delivery is traumatic and probably breach
• Child will have a firm palpable mass within the first four weeks of life.
• Conditions associated – Molding disorder or packaging deformity such as hip dysplasia (DDH) and metatarsus adductus (up to 20%).
•  X-rays of the cervical spine are needed to exclude other conditions such as rotatory C1, C2 instability and Klippel Feil syndrome.
• Ultrasound can differentiate between mild cases and severe fibrosis.
• Differential diagnosis: Rotatory Atlanto-axial instability/ Grisel’s disease, Klippel Feil syndrome.

Treatment

• Usually resolves spontaneously in about 90% of infants by passive stretching in the first year
• Stretching technique should include lateral head tilt away from the affected side and chin rotation towards the affected side.
• Passive Treatment may be guided by the findings in USG of the muscle.
• Surgical treatment by Z plasty is done if the child is older than 1 year with severe limitation or rotation.

Courtesy: Prof Nabile Ebraheim, University of TOledo, Ohio, USA