Congenital Muscular Torticollis is usually caused by
contracture of the sternocleidomastoid muscle and usually occurs in infants.
The cause of congenital muscular torticollis is unknown. It may be caused form
pressure on the muscle or compartment syndrome of the muscle. The child holds
the head towards the affected side with the chin rotated towards the opposite
side. There is difficulty in turning the head due to a tight and shortened
sternocleidomastoid muscle. It is a common neck problem in childhood and the
condition usually resolves itself spontaneously over a period of several
months.
Conditions associated with congenital muscle torticollis:
Molding disorder or packaging deformity such as hip
dysplasia (DDH) and metatarsus adductus (up to 20%). Usually delivery is
traumatic and probably breach.
Child will have a frim palpable mass within the first four
weeks of life and a head tilt.
X-rays of the cervical spine are needed to exclude other
conditions such as rotatory C1-C2 instability and Klippel Feil syndrome.
Ultrasound is important as it can differentiate between mild
cases and severe fibrosis.
Differential diagnosis of Congenital Muscular Torticollis:
Rotatory Atlanto-axial instability/ Grisel’s disease and Klippel
Feil syndrome. These conditions are serious.
Congenital Muscular Torticollis usually resolves
spontaneously in about 90% of infants by passive stretching in the first year.
Passive stretching technique should include lateral head tilt away from the affected
side and chin rotation towards the affected side.
Treatment may be guided by
the findings in ultrasound examination of the muscle. Surgical treatment by Z
plasty is done if the child is older than 1 year with severe limitation or
rotation.
