Torticollis

Torticollis is a condition that occurs when an infant’s neck becomes twisted, causing his or her head to tilt to one side. The twisting in the neck is caused by a shortened sternocleidomastoid (SCM) muscle. Other terms for torticollis include wry neck or loxia. Torticollis falls into two categories: congenital torticollis and acquired torticollis.

• Congenital torticollis is the most common type of torticollis. It occurs in less than 1-3.9% of infants. It usually occurs as a result of abnormal positioning in the womb or a difficult birth which stretched the SCM muscle, or the muscle that extends down the neck. Signs typically become evident within the first 8 weeks of life.
• Acquired torticollis has its onset in infancy or later childhood. It usually results from an injury or inflammation in the sternocleidomastoid or trapezius muscles. Because congenital torticollis is the most common form, it will be the focus of our practice area.

Signs and Symptoms of Torticollis

Infants with torticollis may have the following:

• A head which tilts to one side while the chin tilts to the other
• A flattened area or an asymmetrical shape (positional plagiocephaly) on one side of the head from always sleeping on that side. This condition could also be caused by crowding in the womb, however.
• A soft lump in the neck muscle (this occurs in the first few weeks)
• Pain or tenderness in the sternocleidomastoid or trapezius muscles
• Limited range of motion in the cervical spine

Causes of Torticollis

The most common cause of torticollis is muscle injury or inflammation from positioning in the womb or a difficult birth. However, there are other possible causes of torticollis that range from minor to severe. The following conditions can cause wryneck:

• Acute Infections
• Atlantoaxial Rotary Subluxation
• Spasmus Nutans
• Benign Paroxysmal Torticollis
• Sandifer Syndrome
• Dystonic Reaction
• Ocular Torticollis
• Various Rare Conditions
• Retropharyngeal Abscess
• Cervical Spine Injury
• Suppurative Jugular Thrombophlebitis
• Spinal Epidural Hematoma
• Central Nervous System Tumor
• Klippel-Feil Syndrome

Diagnosis of Torticollis

Because the causes of torticollis can be severe, it is imperative that signs and symptoms be reported to a medical professional. The doctor will conduct a physical examination, followed by x-rays, imaging tests, and ultrasound scans when necessary, in order to determine the cause of torticollis.

Treatment for Torticollis

Muscular torticollis is usually mild and will resolve after a few weeks with treatment of assigned exercises that can stretch the SCM muscle.

These exercises involve specific moves as the doctor instructs. They may include ways of encouraging the infant to turn his or her head to the side that or she doesn’t normally turn to. This may mean laying the infant down on the changing table or crib so that people approach on the side they don’t normally turn to. Parents may also be encouraged to feed the baby more often on the side they wouldn’t normally turn to. Finally, giving the infant the proper amount of tummy time will also help to solve their muscular torticollis.

If necessary, a doctor may refer a patient to an orthopaedic surgeon or physical therapist.