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Congenital muscular torticollis (CMT) is a condition that involves the sternocleidomastoid muscle of the neck. It is the third most common congenital musculoskeletal anomaly found infants. An infant often presents with his head tilted and/or turned to one side. Torticollis affects approximately 1/1000 children.

 

Diagnosis:

Diagnosis of torticollis is made after ruling out other potential diagnoses. Confirmation of the torticollis can be made by ultrasound of the neck by your pediatrician, but is often not necessary, as it is easily observed on clinical examination. The side of the torticollis is named by the direction to which the head is tilted and/or to the side opposite to which the head is turned. For example, a child with a left-sided torticollis will have his head tilted to the left and/or turned to the right. A child may present with the side tilt, the rotation, or both. Logically, the physical therapy interventions will then be focused on activities that encourage your child to tilt and turn his head in the opposite direction of the torticollis.

 

A pediatrician or pediatric physical therapist will often identify an infant with torticollis early during development. However, sometimes torticollis is overlooked or goes unnoticed for months, which can make treating the condition more complicated and lengthy- possibly even leading to surgery.

 

Possible Causes of CMT:

• Intrauterine positioning, especially during the 3rd trimester with decreased available intrauterine space, may make it difficult for a baby to maneuver itself and cause it to remain in one position over an extended period of time.
• Difficulty during the delivery causing a hematoma within the SCM muscle during development that may scar down as it heals, later causing a shortening of the SCM to occur
• Larger infants who have difficulty with head control at a young age
• Gastroesophageal reflux disease (GERD) causing an infant to turn his head away from the feeder throughout the day
• Static positioning in carriers, strollers, throughout the day

Treatment of Torticollis:

Treatment of torticollis begins with an extensive review of your child’s history. We determine factors during or after the pregnancy that might have contributed to the torticollis. We also rule out other more serious differential diagnoses that may warrant further consultation with your pediatrician, a pediatric neurologist, or pediatric orthopedist. The focus of the intervention is on educating you, the caregiver, how to treat your child at home.

 

With the clinical recommendations regarding specific positioning, stretching, and strengthening activities, torticollis can significantly improve when treated within the first few months of diagnosis.

 

Cranial anomalies associated with torticollis:

Plagiocephaly, known to parents as a "flat head", is commonly associated with torticollis due to the abnormal forces placed on the child’s head as a result of the head tilted or turned towards one direction. A child may present with asymmetries of the face and back or side of the head as a result. Depending on the severity of the plagiocephaly, some children may have to utilize devices such as a special helmet, a DOC band, or a TOT collar for several months.

 

All in all, if you notice that your child has difficulty turning his or her head to one side or is visibly tilting to one side, then consult your pediatrician or find a pediatric physical therapist in your area to rule this out.

 

References:

American Physical Therapy Association website
1) Livingston, GL, Saluti, S, Torticollis: Orthopedic Interventions for Pediatric Patients: The evidence for effectiveness, American Physical Therapy Association.

2) Leach J. Orthopedic Conditions. In: Campbell, SK, Vander Linden DC, Palisano RJ, eds. Physical Therapy for Children. Philadelphia, Pa: WB Saunders; 1995: 374-375

3) Cheng, JY, Wong MN, Tank SP, Chen TK< Shum SF, Wong EC. Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants. J Bone Joint Surg Am. 2001; 83:679-687