Torticollis

Key Features

• Occasionally associated with congenital deformities of the cervical spine

• Radiographs of the spine are indicated in most cases where such anomalies are suspected

• There is a 15–20% incidence of associated hip dysplasia

Clinical Findings

• Injury to the sternocleidomastoid muscle during delivery or disease affecting the cervical spine in infancy, such as congenital vertebral anomalies

• When contracture of the sternocleidomastoid muscle causes torticollis, the chin is rotated to the side opposite of the affected muscle, causing the head to tilt toward the side of the contracture

• A mass felt in the midportion of the sternocleidomastoid muscle in a newborn is likely a hematoma or developmental fibroma, rather than a true tumor.

• Acute torticollis may follow upper respiratory infection or mild trauma in children

Diagnosis

• CT scan is required for accurate assessment of rotatory subluxation of the upper cervical spine

• Other causes of torticollis include spinal cord and cerebellar tumors, syringomyelia, and rheumatoid arthritis

Treatment

• If left untreated in early infancy, a striking facial asymmetry can persist

• Passive stretching is an effective treatment in up to 97% of all cases

• If the deformity does not correct with passive stretching during the first year of life, surgical release of the muscle origin and insertion can be an effective treatment option

• Excising the "tumor" of the sternocleidomastoid muscle is unnecessary and creates an unsightly scar

• For acquired torticollis in childhood, traction or a cervical collar usually results in resolution of the symptoms within 1 or 2 days