Diagram of the Cervical Spine (neck) showing normal anatomy
Congenital muscular torticollis, a painless form of head tilting, is the most common cause of a wry-neck posture in the infant. It is often discovered during the first 6 to 8 weeks of life.
“Congenital” means a condition that is present at birth. Congenital torticollis occurs at or shortly after birth.
Symptoms
This condition does not cause pain. Either side can be affected although it is often more common in the right (75%).
The infant keeps his or her head tilted toward the affected side and the chin rotated toward the opposite shoulder. He or she will also have difficulty turning the head from side to side.
A olive-shaped lump may be visible or felt on the affected side in the first 3 months of life. The lump may eventually disappear as a tight fibrous band is replaced over the length of the neck muscle.
Causes
Congenital torticollis occurs when the neck muscle, known as the sternocleidomastoid muscle, that runs up and toward the back of the infant’s neck is shortened. This tilts the head down and to one side. This is known as congenital muscular torticollis.
We still don’t know exactly what causes the shortened neck muscle. We think that the muscle may have had a small tear or it may be stretched during the baby’s birth. The tear causes bleeding and swelling. And scar tissue replaces some of the muscle, making it shorter.
More recently, it has been postulated that the sternomastoid muscle shortens as a result of scarring due to a vascular disturbance in the womb. Still others think that it is due to position of the baby’s head in the womb causing fibrosis or shortening of the muscle.
Some cases of congenital torticollis are caused by a bone problem in the neck portion of the spine (cervical spine). This is known as a congenital malformation of the cervical spine.
Torticollis may also occur later in life, but this is not congenital torticollis.
Risk Factors
Risk factors include a breech pregnancy (where the fetus is leg-down instead of face-down) and a difficulty delivery. However, most congenital torticollis occur without any apparent cause in otherwise healthy infants.
Congenital torticollis has been associated with two other birth conditions:
- Developmental dysplasia of the hip (DDH) – hip joint dislocation present at birth.
- Metatarsus adductus – the front of the foot is bent or angled in toward the middle of the foot.
Investigations
What does your doctor do about it?
- After a thorough history and examination, your doctor should be able to tell if the torticollis is muscular.
- Movement is quite rigid around the neck if the torticollis is caused by a spine problem, and difficult to correct passively. There are usually other symptoms or signs that suggest an underlying problem. In these cases, X-ray and/or other forms of imaging such as MRI may be required.
- On the other hand, muscular torticollis, even in the more severe cases, can be corrected passively to some extent.
- There is a 20% incidence of hip dysplasia children with muscular torticollis. So your doctor will perform an ultrasound exam of the hips in the first 4 to 6 weeks of life to rule that out.
Complications
If the problem of wry-neck is not corrected, some of the complications that will appear as the child grows include:
- Asymmetry of skull and face – the face of the affected side may remain “flattened”. This is only reversible if the torticollis is corrected before age 1.
- Permanent limitations in head and neck movements.
Treatment
Initial treatment consists of a massage and stretching program, which is successful in most cases when started in the first 6 months of life.
The exercises stretch the contracted neck muscle and they should be attempted 15 to 20 times, 4 to 6 times a day.
Instructions for stretching and positioning right torticollis (orthoseek)
Instructions for stretching and positioning left torticollis (orthoseek)
Other ways you can do to help your child stretch their neck is to encourage movements such as tilting of the head towards the affected side. For example:
- Arrange the child’s crib in a way that he or she has to tilt the chin the correct way to see the room.
- Place objects in such a way that your child has to turn the head to see them.
- During feeding, hold the baby in a way where he or she has to turn the neck to reach the nipple.
Seeking Advice
Seek medical advice early as congenital torticollis is largely reversible with early treatment.
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
Unfortunately there is nothing to prevent congenital torticollis from happening. However, early movement of the neck is critical to prevent irreversible symptoms and complications.
F.A.Q. | Frequently Asked Questions
References
Wudbhar, N. et.al., ‘Orthopaedic Conditions in the Newborn’, Journal of American Academy of Orthopaedic Surgeons, Vol. 17, 2009, pp. 112-122