Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Congenital contracture of the sternocleidomastoidCongenital wry neckCongenital sternomastoid torticollisTorticollisLoxia ++ 754.1 Congenital musculoskeletal deformities of sternocleidomastoid muscle ++ Q68.0 Congenital deformity of sternocleidomastoid muscle ++ 4B: Impaired posture4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation +++ Description ++ Torticollis is a postural position of the neck with side bending and opposite rotationTerm used to describe asymmetrical posturing of neck due to shortened sternocleidomastoidContracted 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 idiopathicCongenital muscular torticollis is the most common type2Hip dysplasia in 20% of casesAt risk for scoliosisHead tilted to one side and rotated to opposite side typically noted in first 6 to 8 weeks of life +++ Demographics ++ Affects 1 in 250 infants3Right torticollis most common (75% of the time)Most common in first born children4 +++ Signs and Symptoms ++ Asymmetrical posturing of neck with lateral flexion on the affected side and rotation towards the unaffected sidePalpable mass on sternocleidomastoid until 4 to 6 months of ageFacial asymmetriesFlattened posterior skullDecreased passive and/or active range of motionPostural asymmetriesAsymmetrical cervical skin foldsPainEnlargement of the neck musclesSwelling of neck muscles at birth with congenitalShoulder elevation on affected sidePossible difficulty swallowing5 +++ Functional Implications ++ Postural control abnormalitiesMay have limited active and/or passive movement of the headFacial asymmetriesCranial asymmetries (deformational plagiocephaly)Gross motor asymmetriesDevelopmental delay6Greater reliance on vision for maintaining postural stability7 +++ Possible Contributing Causes ++ Difficult labor (birth)Awkward positioning in uteroTrauma during delivery resulting in hematoma of sternocleidomastoid, which may result in a palpable mass8InfectionGastrointestinal reflux7Sprengel’s deformityMusculoskeletal anomalies such as hemivertebraeNeurological disorder such as Klippel-Feil syndromeOcular abnormalities +++ Differential Diagnosis ++ Inherited torticollis: change in chromosomesAcquired torticollis: damage to muscle or nerveIdiopathic torticollis: unknown causeOcular torticollisPosterior fossa tumorSyringomyelia +++ Imaging ++ X-rayElectromyography (EMG)Ultrasound of hipsComputerized tomography (CT) scan to rule out osseous anomaliesMagnetic resonance imaging (MRI) if neurological etiology suspectedRule out congenital deformities of the cervical spine, ocular anomalies, CNS pathology4, neoplasm, thyroiditis, endocrine disease3 +++ Diagnostic Procedures ++ Diagnosis is made ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.