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  • Congenital contracture of the sternocleidomastoid
  • Congenital wry neck
  • Congenital sternomastoid torticollis
  • Torticollis
  • Loxia

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  • 754.1 Congenital musculoskeletal deformities of sternocleidomastoid muscle

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  • Q68.0 Congenital deformity of sternocleidomastoid muscle

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Description

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  • Torticollis is a postural position of the neck with side bending and opposite rotation
  • Term used to describe asymmetrical posturing of neck due to shortened sternocleidomastoid
  • Contracted state of the cervical muscles with sternocleidomastoid enlargement

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Essentials of Diagnosis

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  • Congenital torticollis believed to result from improper position of the fetus in utero, with changes in the blood supply or muscles of the neck or trauma during delivery

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General Considerations

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  • Can have an etiology or can be idiopathic
  • Congenital muscular torticollis is the most common type2
  • Hip dysplasia in 20% of cases
  • At risk for scoliosis
  • Head tilted to one side and rotated to opposite side typically noted in first 6 to 8 weeks of life

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Demographics

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  • Affects 1 in 250 infants3
  • Right torticollis most common (75% of the time)
  • Most common in first born children4

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Signs and Symptoms

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  • Asymmetrical posturing of neck with lateral flexion on the affected side and rotation towards the unaffected side
  • Palpable mass on sternocleidomastoid until 4 to 6 months of age
  • Facial asymmetries
  • Flattened posterior skull
  • Decreased passive and/or active range of motion
  • Postural asymmetries
  • Asymmetrical cervical skin folds
  • Pain
  • Enlargement of the neck muscles
  • Swelling of neck muscles at birth with congenital
  • Shoulder elevation on affected side
  • Possible difficulty swallowing5

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Functional Implications

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  • Postural control abnormalities
  • May have limited active and/or passive movement of the head
  • Facial asymmetries
  • Cranial asymmetries (deformational plagiocephaly)
  • Gross motor asymmetries
  • Developmental delay6
  • Greater reliance on vision for maintaining postural stability7

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Possible Contributing Causes

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  • Difficult labor (birth)
  • Awkward positioning in utero
  • Trauma during delivery resulting in hematoma of sternocleidomastoid, which may result in a palpable mass8
  • Infection
  • Gastrointestinal reflux7
  • Sprengel’s deformity
  • Musculoskeletal anomalies such as hemivertebrae
  • Neurological disorder such as Klippel-Feil syndrome
  • Ocular abnormalities

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Differential Diagnosis

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  • Inherited torticollis: change in chromosomes
  • Acquired torticollis: damage to muscle or nerve
  • Idiopathic torticollis: unknown cause
  • Ocular torticollis
  • Posterior fossa tumor
  • Syringomyelia

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Imaging

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  • X-ray
  • Electromyography (EMG)
  • Ultrasound of hips
  • Computerized tomography (CT) scan to rule out osseous anomalies
  • Magnetic resonance imaging (MRI) if neurological etiology suspected
  • Rule out congenital deformities of the cervical spine, ocular anomalies, CNS pathology4, neoplasm, thyroiditis, endocrine disease3

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Diagnostic Procedures

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  • Diagnosis is made by clinical observation
  • Torticollis rating scale of Tsui

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