TORTICOLLIS

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Etiology and Epidemiology

Torticollis is usually first identified in newborns because of a head tilt. Torticollis is usually secondary to a shortened sternocleidomastoid muscle (muscular torticollis). This may result from in utero positioning or birth trauma. Acquired torticollis may be related to upper cervical spine abnormalities or central nervous system pathology (mass lesion). It can also occur in older children during a respiratory infection (potentially secondary to lymphadenitis) or local head or neck infection, and may herald psychiatric diagnoses.

Clinical Manifestations and Evaluation

Infants with muscular torticollis have the ear tilted toward the clavicle on the ipsilateral side. The face will look upward toward the contralateral side. There may be a palpable swelling or fibrosis in the body of the sternocleidomastoid shortly after birth, which is often the precursor of a contracture. Congenital muscular torticollis is associated with skull and facial asymmetry (plagiocephaly) and developmental dysplasia of the hip.
After a thorough neurologic examination, anteroposterior and lateral radiographs should be obtained. The goal is to rule out a nonmuscular etiology. A computed tomography (CT) scan or MRI of the head and neck is necessary for persistent neck pain, neurologic symptoms, and persistent deformity.

Treatment

Treatment of muscular torticollis is aimed at increasing the range of motion of the neck and correcting the cosmetic deformity. Stretching exercises of the neck can be very beneficial for infants. Surgical management is indicated if patients do not improve with adequate stretching exercises in physical therapy. Postoperative physical therapy is needed to decrease the risk of recurrence. Treatment in patients with underlying disorders should target the disorder.

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