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Condition/Disorder Synonyms

  • Congenital contracture of the sternocleidomastoid

  • Congenital wry neck

  • Congenital sternomastoid 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

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 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

  • Affects 1 in 250 infants3

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

  • Most common in first born children4

Clinical Findings

Signs and Symptoms

  • 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

Functional Implications

  • 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

Possible Contributing Causes

  • 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

Differential Diagnosis

  • Inherited torticollis: change in chromosomes

  • Acquired torticollis: damage to muscle or nerve

  • Idiopathic torticollis: unknown cause

  • Ocular torticollis

  • Posterior fossa tumor

  • Syringomyelia

Means of Confirmation or Diagnosis

Imaging

  • X-ray

  • Electromyography (EMG)

  • Ultrasound of hips

  • Computerized tomography (CT) scan to rule out osseous anomalies

  • Magnetic resonance ...

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