Ortho

Congenital Torticollis

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Congenital Torticollis

  • Etiologies
  1. Sternocleidomastoid Muscle injury from Birth Trauma
    1. Hematoma and fibrosis results in Muscle shortening
  2. Muscle adaptation from abnormal intrauterine position
  3. Cervical Vertebral abnormalities
    1. Suggested by limited neck range of motion at birth
  • Pathophysiology
  1. Unilateral shortening of Sternocleidomastoid Muscle
  • Associated Conditions
  1. Congenital asymmetric contractures of hip abductors
  2. Unilateral Congenital Hip Dysplasia
  3. Unilateral Metatarsus Adductus
  • Signs
  1. Head Tilt toward the affected side
  2. Limited neck range of motion
    1. May suggest cervical Vertebral abnormality
  3. Face and skull asymmetry from lack of position change
  4. Palpable mass within Sternocleidomastoid Muscle
    1. Gradually disappears and is replaced by fibrous knot
  • Images
  1. NeckLateralMuscles.jpg
  • Radiology
  1. Neck XRay
    1. Indicated for significantly limited neck ROM
  2. Ultrasound Hips
    1. Assess for concurrent Congenital Hip Dysplasia
    2. Indicated for significant hip abductor tightness
  • Management
  1. Positioning head opposite affected side
    1. Padded bricks
    2. Sandbags
  2. Passive Stretching
    1. Rotate infants head to affected side
    2. Tilt head backwards (extend) away from affected side
  3. Surgical release of sternocleiodomastoid Muscle
    1. Indicated for limited range of motion at 1 year
  • Course
  1. Minimal signs at birth
  2. Torticollis evident by 2 to 3 weeks
  3. Recovery over 3 to 4 months with therapy
  4. Complete resolution by 1 year with therapy
  • Complications
  1. Positional Head Deformity (Positional Plagiocephaly)