What are the other Names for this Condition? (Also known as/Synonyms)

• Congenital Sternomastoid Torticollis
• Congenital Torticollis
• Congenital Wryneck

What is Congenital Muscular Torticollis? (Definition/Background Information)

• Torticollis is a muscular disorder that results in a twisted neck or a sideways tilted head, due to muscles of neck undergoing abnormal muscle contractions. It can be congenital or acquired
• Congenital Muscular Torticollis (CMT) is thought to occur due to some underlying genetic/physiological abnormality, improper positioning of the fetus while still in the uterus, or due to a birth-related trauma that causes injury to certain neck muscles
• Around 80-90% of CMTs are also associated with skull distortion causing facial asymmetry, and between 10-20% of the cases with hip joint malformations (termed as hip dysplasia)
• The muscular condition can be completely cured in most cases using therapy and exercises, by or before age one

Who gets Congenital Muscular Torticollis? (Age and Sex Distribution)

• Congenital Muscular Torticollis is a common condition affecting the newborn child. It may be present at birth, but sometimes not discovered until the 6th-8th week, or even till much later
• The general incidence of this condition is around 1 in 250-300 live births
• Both males and females are equally affected
• No racial preference is seen, and no worldwide geographical restriction is noted

What are the Risk Factors for Congenital Muscular Torticollis? (Predisposing Factors)

Risk factors for Congenital Muscular Torticollis include:

• Congenitally inherited disorders, like Klippel-Feil syndrome, that affect the neck bones (vertebrae)
• Neurological and/or muscular impairment due to tumor growth, affecting the brain or spinal cord
• Difficult or complicated delivery that might risk injury to the newborn
• Any undue mechanical or physiological stresses during fetal development

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Congenital Muscular Torticollis? (Etiology)

• The primary basis of Congenital Muscular Torticollis is a contraction or excessive shortening of the sternocleidomastoid muscle (SCM) located in the neck, leading to slanting of the head towards one side and limiting muscular motion range
• This may occur due to a host of factors and there are several explanations why this damage and muscle impairment might take place. These include: Intrauterine crowding, traumatic neck muscle injury during delivery, compartment syndrome due to tissue compression, inherited abnormalities (of the vertebrae or spinal cord)

What are the Signs and Symptoms of Congenital Muscular Torticollis?

In some infants with Congenital Muscular Torticollis, the wry neck appearance may be mild and almost invisible. However, it may progressively worsen if left untreated, causing facial asymmetry. CMT presents the following signs and symptoms:

• Head tilted to one side (mostly to the right side), with limited movement of the neck. The abnormal head position becomes apparent after a few months
• Due to the baby frequently sleeping on one side, the head or skull base may flatten and acquire an asymmetrical shape
• A soft tumorous swelling may be noticed in the neck region, which may be present for 4-8 months, on the side towards which the head slant is observed
• Extreme head postures may create breastfeeding issues; feeding from one of the breasts, may be difficult

How is Congenital Muscular Torticollis Diagnosed?

A simple physical examination of the neck by the pediatrician, with study of birth history may be conclusive enough to arrive at a Torticollis diagnosis. However, in order to determine the extent of the condition, the type of muscles involved with Congenital Muscular Torticollis, and other coexisting conditions; certain diagnostic tests are performed:

• Physical exam with evaluation of medical history
• X-ray of the neck (cervical spine assessment)
• Ultrasound scan of the neck and hip (if hip dysplasia is suspected)
• Physical examination to assess infant’s ability, in performing basic age-appropriate physical activities
• Tests to determine other underlying conditions, such as neurological exam, MRI scan for skeletal survey, and ophthalmologic evaluation

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Congenital Muscular Torticollis?

Complications of Congenital Muscular Torticollis are mainly linked to the extent of the condition (severe twisted neck situation), and the presence of secondary medical disorders.

How is Congenital Muscular Torticollis Treated?

The treatment measures for Congenital Muscular Torticollis are basically meant to prevent worsening of the condition and correct the defect. The interventions could be surgical or non-surgical.

Surgical methods are mainly used if the condition is classified as severe by the physician and do not improve after non-surgical procedures, which form the usual line of treatment. The management measures include:

• Physical therapy; to gently help increase range of motion and provide proper shape to the head, to prevent further muscle contracture and loss of muscle function. This is achieved by using age-suitable stretching and musculoskeletal strengthening exercise program, which helps in decreasing muscle fatigue and stress
• Use of special child neck collar (called TOT collar), after the age of 4 months
• Application of warm compress, or heat
• Surgical techniques are employed if symptoms persist after one year of conservative management of the condition. This is then followed by post-surgical physiotherapy
• If required, Botox injections may be used to improve and strengthen the muscle condition

How can Congenital Muscular Torticollis be Prevented?

• In some cases Congenital Muscular Torticollis may be preventable (like ensuring that baby delivery process is performed carefully). Though, in most cases it cannot be prevented

What is the Prognosis of Congenital Muscular Torticollis? (Outcomes/Resolutions)

• Majority of the times, Congenital Muscular Torticollis can be treated to complete recovery within a year (90% success rate)
• The best results are when the baby is very young, the condition is diagnosed quickly and therapy commenced, as early as possible
• If prolonged therapy fail to achieve results, then surgical intervention may be required to correct the muscular defect

Additional and Relevant Useful Information for Congenital Muscular Torticollis:

• It is thought that Torticollis and dislocation of the hip have a greater chance of occurrence among first-born children, due to the layout and construction of uterus that exists, prior to first conception
• Parents of a Congenital Muscular Torticollis child are taught easy and simple training steps to provide regular physical therapy to the infant child, while at home. This is done so, when the ‘head tilt’ is not of a high order, and other abnormalities/disorders that may complicate the situation, are absent