Congenital torticollis

What is congenital torticollis?

Torticollis, also known as ironic neck, is a condition in which the patient’s neck is abnormally twisted, leaving the head at an asymmetrical angle. It is often painful and difficult to turn the head from this position.

There are two categories of torticollis: acquired and congenital. Congenital means that the patient was born with the condition. Although acquired torticollis can be caused by anything from scarring of muscle tissue to swollen lymph nodes, congenital torticollis usually occurs because the infant’s sternocleidomastoid muscle, which runs down one side of the neck, is too short and tight.

Prognosis of congenital torticollis

In most cases, congenital torticollis can be overcome over time if treated correctly with stretching exercises and simple changes in the way the baby is held.

Symptoms of congenital torticollis

The key symptom is the position of the head; tilted to one side with the chin pointing toward the opposite shoulder. In three out of four infants with a twisted neck, the right side of the neck is affected. Other symptoms include:

  • Limited range of motion in the head and neck.
  • A soft lump may be felt in the baby’s neck for the first few weeks after birth, which gradually disappears. It does not appear to cause pain to the baby.
  • One side of the face may flatten because the baby sleeps on the same side all the time.

Congenital muscular torticollis is usually noticed within the first six to eight weeks after birth, as the baby gains more control over his or her body, but struggles with his or her head and neck.

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Some babies born with a crooked neck also have developmental dysplasia of the hip. This is a condition in which the thigh bone fits loosely in the joint and can easily slip out of the hip socket.

In three out of four infants with a crooked neck, the right side of the neck is affected.

What are the causes of congenital torticollis?

The exact cause of a crooked neck is unclear, but some believe it is related to the baby’s position in the uterus or during delivery, which injures the neck muscle. Congenital torticollis appears to be more common in firstborns, who have less space in the uterus than their later siblings.

Treatments for congenital torticollis

Treatment may depend on the age of the child and the severity of the condition. In most cases, the first line of treatment is a regimen of stretching exercises to lengthen the infant’s sternocleidomastoid muscle. This usually involves the parent gently turning the infant’s head as instructed by a physician or physical therapist. The baby can also be encouraged to practice stretching the muscle by placing toys so that they have to turn their head to look at them, or sitting on their limited side so that they have to turn to look at you. In about 10% of cases, these conservative methods are not successful and surgery may be recommended.

What type of specialist treats congenital torticollis?

Pediatricians, pediatric physical therapists and pediatric surgeons may be involved in the treatment of congenital torticollis.