Congenital torticollis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Congenital torticollis is a neck deformity that involves shortening of the sternocleidomastoid (SCM) muscle resulting in limited neck rotation and lateral flexion.
Infants tilt their head toward the side of the shortened muscle and rotate to the contralateral side.
Plagiocephaly and craniofacial deformities can be associated with congenital muscular torticollis (CMT) and can perpetuate one another.
Developmental hip dysplasia can be associated with CMT.
It is important to rule out nonmuscular causes such as ocular, vertebral, and neurologic.

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Images

Vertex view of a head depicting typical findings of plagiocephaly associated with congenital muscular torticollis. Note the typical parallelogram shape due to asymmetric external compressive forces and associated growth. *Denotes the side of the shortened sternocleidomastoid and resultant torticollis
Cervical spine x-ray showing numerous segmentation anomalies associated with a convex left cervicothoracic scoliosis. This patient presented with a head tilt. There are segmentation anomalies in the lower thoracic and high cervical region. There is an acute convex left cervicothoracic scoliosis with a hemivertebra at the apex of the curve. Butterfly vertebra is identified rostral to the hemivertebra, and segmentation anomalies are also identified caudal to the hemivertebra

Citations

Key Articles

Cheng JC, Wong MW, Tang SP, et al. Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants. A prospective study of eight hundred and twenty-one cases. J Bone Joint Surg Am. 2001;83-A(5):679-87.[Abstract]
Cheng JC, Au AW. Infantile torticollis: a review of 624 cases. J Pediatr Orthop. 1994;14:802-808.[Abstract]
Binder H, Eng GD, Gaiser JF, et al. Congenital muscular torticollis: results of conservative management with long-term follow-up in 85 cases. Arch Phys Med Rehabil. 1987 Apr;68(4):222-5.[Abstract]
Positioning and sudden infant death syndrome (SIDS): update. American Academy of Pediatrics Task Force on Infant Positioning and SIDS. Pediatrics. 1996;98:1216-1218.[Abstract]
Emery C. The determinants of treatment duration for congenital muscular torticollis. Phys Ther. 1994 Oct;74(10):921-9.[Abstract][Full Text]
Cheng JC, Tang SP, Chen TM, et al. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants - a study of 1,086 cases. J Pediatr Surg. 2000 Jul;35(7):1091-6.[Abstract]
Cheng JC, Tang SP. Outcome of surgical treatment of congenital muscular torticollis. Clin Orthop Relat Res. 1999 May;(362):190-200.[Abstract]

Referenced Articles

1. Macdonald D. Sternomastoid tumour and muscular torticollis. J Bone Joint Surg Br. 1969;51:432-443.[Abstract]
2. Cheng JC, Wong MW, Tang SP, et al. Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants. A prospective study of eight hundred and twenty-one cases. J Bone Joint Surg Am. 2001;83-A(5):679-87.[Abstract]
3. Williams CR, O'Flynn E, Clarke NM, Morris RJ. Torticollis secondary to ocular pathology. J Bone Joint Surg Br. 1996;78-B:620-624.[Abstract][Full Text]
4. Stevens P, Downey C, Boyd V, et al. Deformational plagiocephaly associated with ocular torticollis: a clinical study and literature review. J Craniofac Surg. 2007;18:399-405.[Abstract]
5. Kumandas S, Per H, Gumus H, et al. Torticollis secondary to posterior fossa and cervical spinal cord tumors: report of five cases and literature review. Neurosurg Rev. 2006;29:333-338.[Abstract]
6. Ballock RT, Song KM. The prevalence of nonmuscular causes of torticollis in children. J Pediatr Orthop. 1996;16:500-504.[Abstract]
7. Herman MJ. Torticollis in infants and children: common and unusual causes. Instr Course Lect. 2006;55:647-653.[Abstract]
8. Cheng JC, Au AW. Infantile torticollis: a review of 624 cases. J Pediatr Orthop. 1994;14:802-808.[Abstract]
9. Kaplan SL, Coulter C, Fetters L. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatr Phys Ther. 2013 Winter;25(4):348-94.[Abstract]
10. Binder H, Eng GD, Gaiser JF, et al. Congenital muscular torticollis: results of conservative management with long-term follow-up in 85 cases. Arch Phys Med Rehabil. 1987 Apr;68(4):222-5.[Abstract]
11. Dunn PM. Congenital sternomastoid torticollis: an intrauterine postural deformity. Arch Dis Child. 1974 Oct;49(10):824-5.[Abstract][Full Text]
12. Positioning and sudden infant death syndrome (SIDS): update. American Academy of Pediatrics Task Force on Infant Positioning and SIDS. Pediatrics. 1996;98:1216-1218.[Abstract]
13. Kane AA, Mitchell LE, Craven KP, et al. Observations on a recent increase in plagiocephaly without synostosis. Pediatrics. 1996;97:877-885.[Abstract]
14. Argenta LC, David LR, Wilson JA, et al. An increase in infant cranial deformity with supine sleeping position. J Craniofac Surg. 1996;7:5-11.[Abstract]
15. Turk AE, McCarthy JG, Thorne CH, et al. The "back to sleep campaign" and deformational plagiocephaly: is there cause for concern? J Craniofac Surg. 1996;7:12-18.[Abstract]
16. Emery C. The determinants of treatment duration for congenital muscular torticollis. Phys Ther. 1994 Oct;74(10):921-9.[Abstract][Full Text]
17. Peitsch WK, Keefer CH, LaBrie RA, et al. Incidence of cranial asymmetry in healthy newborns. Pediatrics. 2002;110:e72.[Abstract]
18. Littlefield TR, Kelly KM, Pomatto JK, et al. Multiple-birth infants at higher risk for development of deformational plagiocephaly: II. Is one twin at greater risk? Pediatrics. 2002;109:19-25.[Abstract]
19. Ho BC, Lee EH, Singh K. Epidemiology, presentation and management of congenital muscular torticollis. Singapore Med J. 1999;40:675-679.[Abstract]
20. Hsu TC, Wang CL, Wong MK, et al. Correlation of clinical and ultrasonographic features in congenital muscular torticollis. Arch Phys Med Rehabil. 1999;80:637-641.[Abstract]
21. Tang S, Liu Z, Quan X, et al. Sternocleidomastoid pseudotumor of infants and congenital muscular torticollis: fine-structure research. J Pediatr Orthop. 1998;18:214-218.[Abstract]
22. Joiner ER, Andras LM, Skaggs DL. Screening for hip dysplasia in congenital muscular torticollis: is physical exam enough? J Child Orthop. 2014 Mar;8(2):115-9.[Abstract][Full Text]
23. Kim SN, Shin YB, Kim W, et al. Screening for the coexistence of congenital muscular torticollis and developmental dysplasia of hip. Ann Rehabil Med. 2011 Aug;35(4):485-90.[Abstract][Full Text]
24. Von Heideken J, Green DW, Burke SW, et al. The relationship between developmental dysplasia of the hip and congenital muscular torticollis. J Pediatr Orthop. 2006 Nov-Dec;26(6):805-8.[Abstract]
25. Walsh JJ, Morrissy RT. Torticollis and hip dislocation. J Pediatr Orthop. 1998 Mar-Apr;18(2):219-21.[Abstract]
26. Tien YC, Su JY, Lin GT, et al. Ultrasonographic study of the coexistence of muscular torticollis and dysplasia of the hip. J Pediatr Orthop. 2001 May-Jun;21(3):343-7.[Abstract]
27. Dudkiewicz I, Ganel A, Blankstein A. Congenital muscular torticollis in infants: ultrasound-assisted diagnosis and evaluation. J Pediatr Orthop. 2005;25:812-814.[Abstract]
28. Huang MH, Gruss JS, Clarren SK, et al. The differential diagnosis of posterior plagiocephaly: true lambdoid synostosis versus positional molding. Plast Reconstr Surg. 1996;98:765-774.[Abstract]
29. Kaplan SL, Coulter C, Sargent B. Physical therapy management of congenital muscular torticollis: a 2018 evidence-based clinical practice guideline from the APTA Academy of Pediatric Physical Therapy. Pediatr Phys Ther. 2018 Oct;30(4):240-90.[Abstract][Full Text]
30. Kuo AA, Tritasavit S, Graham JM Jr. Congenital muscular torticollis and positional plagiocephaly. Pediatr Rev. 2014;35:79-87.[Abstract]
31. Cheng JC, Tang SP, Chen TM, et al. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants - a study of 1,086 cases. J Pediatr Surg. 2000 Jul;35(7):1091-6.[Abstract]
32. Lee YT, Yoon K, Kim YB, et al. Clinical features and outcome of physiotherapy in early presenting congenital muscular torticollis with severe fibrosis on ultrasonography: a prospective study. J Pediatr Surg. 2011 Aug;46(8):1526-31.[Abstract]
33. Teichgraeber JF, Seymour-Dempsey K, Baumgartner JE, et al. Molding helmet therapy in the treatment of brachycephaly and plagiocephaly. J Craniofac Surg. 2004 Jan;15(1):118-23.[Abstract]
34. Xia JJ, Kennedy KA, Teichgraeber JF, et al. Nonsurgical treatment of deformational plagiocephaly: a systematic review. Arch Pediatr Adolesc Med. 2008 Aug;162(8):719-27.[Abstract][Full Text]
35. Jankovic J, Schwartz K. Botulinum toxin injections for cervical dystonia. Neurology. 1990 Feb;40(2):277-80.[Abstract]
36. Delnooz CC, Horstink MW, Tijssen MA, et al. Paramedical treatment in primary dystonia: a systematic review. Mov Disord. 2009 Nov 15;24(15):2187-98.[Abstract]
37. Oleszek JL, Chang N, Apkon SD, et al. Botulinum toxin type a in the treatment of children with congenital muscular torticollis. Am J Phys Med Rehabil. 2005 Oct;84(10):813-6.[Abstract]
38. Joyce MB, de Chalain TM. Treatment of recalcitrant idiopathic muscular torticollis in infants with botulinum toxin type a. J Craniofac Surg. 2005 Mar;16(2):321-7.[Abstract]
39. Qiu X, Cui Z, Tang G, et al. The effectiveness and safety of botulinum toxin injections for the treatment of congenital muscular torticollis. J Craniofac Surg. 2020 Nov/Dec;31(8):2160-66.[Abstract]
40. Cheng JC, Tang SP. Outcome of surgical treatment of congenital muscular torticollis. Clin Orthop Relat Res. 1999 May;(362):190-200.[Abstract]
41. Burstein FD. Long-term experience with endoscopic surgical treatment for congenital muscular torticollis in infants and children: a review of 85 cases. Plast Reconstr Surg. 2004 Aug;114(2):491-3.[Abstract]
42. Lee JK, Moon HJ, Park MS, et al. Change of craniofacial deformity after sternocleidomastoid muscle release in pediatric patients with congenital muscular torticollis. J Bone Joint Surg Am. 2012 Jul 3;94(13):e93.[Abstract]
43. Tessmer A, Mooney P, Pelland L. A developmental perspective on congenital muscular torticollis: a critical appraisal of the evidence. Pediatr Phys Ther. 2010;22:378-383.[Abstract]
44. Hutchison BL, Stewart AW, Mitchell EA. Characteristics, head shape measurements and developmental delay in 287 consecutive infants attending a plagiocephaly clinic. Acta Paediatr. 2009 Sep;98(9):1494-9.[Abstract]