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257: TORTICOLLIS, CONGENITAL

Kay Tasso, PhD, PT, PCS; Eric Shamus, PhD, DPT, PT, CSCS; Ariel Diana Schumer, DPT

CONDITION/DISORDER SYNONYMS

  • Congenital contracture of the sternocleidomastoid

  • Congenital wry neck

  • Congenital sternocleidomastoid torticollis

  • Torticollis

  • Loxia

ICD-9-CM CODE

  • 754.1 Congenital musculoskeletal deformities of sternocleidomastoid muscle

ICD-10-CM CODE

  • Q68.0 Congenital deformity of sternocleidomastoid muscle

PREFERRED PRACTICE PATTERNS1

  • 4B: Impaired Posture

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation

PATIENT PRESENTATION

A 6-month-old is referred to physical therapy with a diagnosis of torticollis. The mother reports she had too little maternal amniotic fluid during the pregnancy and premature rupture of the membranes 2 weeks before the baby was due but no other difficulties during delivery. She reports the infant was born with torticollis but that it is better than at birth. Upon examination, the therapist notes the baby postures into right lateral cervical flexion and left cervical rotation. There is a flattening of the occipital region on the right. The infant will only roll from prone to supine toward the left and supine to prone over the right arm. When placed in prone, the baby puts more weight on the right arm than the left in prone on elbows. When held in supported sitting or standing, the physical therapist notes asymmetry in postural alignment.

KEY FEATURES

Description

  • 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.

Essentials of Diagnosis

  • Congenital torticollis is 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.

General Considerations

  • 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

Demographics

  • 1 in 250 infants3

  • Right torticollis most common (75% of the time)

  • Most common in first born children4

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Asymmetrical cervical skin folds

  • Asymmetrical posturing of neck with lateral flexion on the affected side and rotation toward the unaffected side

  • Decreased passive and/or active range of motion

  • Enlargement of the neck muscles

  • Facial asymmetries

  • Flattened posterior skull

  • Pain

  • Palpable mass on sternocleidomastoid until 4 to 6 months of age

  • Possible difficulty swallowing5

  • Postural asymmetries

  • Shoulder elevation on affected side

  • Swelling of neck muscles at birth with congenital

Functional Implications

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