Congenital Muscular Torticollis
Torticollis (Congenital Muscular Torticollis)
Definition
Congenital muscular torticollis is characterized by unilateral shortening of the sternocleidomastoid muscle, resulting in head tilt toward the affected side and chin rotation to the opposite side.
Epidemiology
- Incidence: 0.3-2% of newborns
- Male:Female ratio = 3:2
- Right side affected more commonly than left
- Associated with breech presentation and difficult deliveries
Pathophysiology
- Intrauterine crowding theory
- Birth trauma theory
- Compartment syndrome theory
- Ischemic theory leading to muscle fibrosis
Clinical Presentation
Key Features
- Head tilt toward the affected side
- Chin rotation to the opposite side
- Limited range of motion
- Palpable sternocleidomastoid mass (in 2/3rd cases)
- Facial asymmetry
Associated Conditions
- Developmental dysplasia of the hip (DDH) - 14.9% association
- Plagiocephaly (skull asymmetry)
- Metatarsus adductus - 10% association
- Developmental delay
Diagnostic Approach
Clinical Assessment
- Passive range of motion measurement
- Head tilt measurement
- Assessment of sternocleidomastoid muscle
- Evaluation for plagiocephaly
Imaging Studies
- Ultrasound: First-line imaging
- Shows muscle thickness
- Identifies fibrotic changes
- Helps differentiate from masses
- X-rays: To rule out
- Cervical spine anomalies
- Klippel-Feil syndrome
- Atlantoaxial instability
- MRI: Reserved for complex cases
Treatment Approach
Conservative Management (Primary Treatment)
- Physical Therapy
- Manual stretching exercises
- Active rotation exercises
- Positioning techniques
- Parent education
- Home Exercise Program
- Stretching exercises 2-3 times daily
- Tummy time
- Environmental modifications
Surgical Management
Indicated if conservative treatment fails after 6-12 months
- Surgical Options:
- Unipolar release
- Bipolar release
- Endoscopic release
- Z-plasty lengthening
Complications and Prognosis
Potential Complications
- Permanent facial asymmetry
- Persistent neck tilt
- Limited range of motion
- Vision problems
- Developmental delays
Prognosis
- Excellent with early intervention (before 1 year)
- Good response to conservative treatment in 90-95% cases
- Factors affecting prognosis:
- Age at presentation
- Severity of restriction
- Compliance with therapy
- Presence of associated conditions
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
