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Torticollis

What is torticollis?

Congenital muscle torticollis (CMT) refers to a condition that occurs when the muscle that runs along each side of the neck, the sternocleidomastoid muscle (SCM), becomes tight, shortened, or weakened, causing the head to tilt and the chin to point  towards one shoulder while the head tilts toward the opposite shoulder. This muscle controls moving the head side to side and up and down. The diagnosis of congenital muscle torticollis is given when a baby is born with the condition and the cause is muscular. It is the most common form of torticollis.  Acquired torticollis can develop at a later time and in some cases the chin will be turned to the same side as the head.

What causes torticollis?

The most common causes for congenital muscular torticollis (CMT) are due to positioning of the baby in the uterus or a trauma to the muscle during birth.  Low amniotic fluid, a large baby, and/or multiples are some of the factors that may cause the baby to not have ample variety of positions in utero and therefore leads to limited range of motion of the neck on one side.

There are a variety of underlying causes for congenital and acquired torticollis which vary not only in severity but in treatment approaches.  Consultation with your pediatrician is imperative to diagnosis which type of torticollis your child might have and what the underlying cause is in order to begin the appropriate treatment protocol.

Torticollis is not always due to muscular problems.  It can be caused by infections, minor trauma, or gastroesophageal reflux. Though rare it can also be caused by bony abnormalities, visual or neurological problems. Another uncommon cause is due to a condition known as Klippel-Feil syndrome. Though the chances your baby has Klippel-Feil syndrome is slim it is important to have your pediatrician rule it out due to other complications associated with this condition.  In addition, the typical treatment protocol for torticollis is not only not effective for infants with Krippel-Fei syndrome but it is potentially dangerous.

What are the symptoms of torticollis?

Congenital torticollis is commonly diagnosed within the first two months of life.

  • Sometimes there is a lump on one side of the neck
  • Head always in the same position when sleeping
  • Head tilts to one side while the chin tilts to the other side
  • Limited range of motion in the head and neck
  • Asymmetries of the face and flattening of one side of the skull (plagiocephaly)
  • Hip dysplasia may also be present

What can torticollis lead to?

Torticollis can lead to other issues such as:

  • Plagiocephaly (flattening of one side of the skull)
  • Movement that favors one side of the body
  • Decreased balance
  • Limited ability to turn the head within a normal range of motion to both sides to fully see, hear, and explore the surroundings, which impacts visual spatial processing and the development of visual motor skills
  • Impaired development of the foundation of movement
  • Limited development of rotational movements which affects the ability to move with smooth coordinated patterns, move through the environment efficiently, and to make quick subtle postural adjustments to prevent losing balance and falling
  • Impaired development of oculomotor and visual spatial skills

What is the treatment for torticollis?

Treatment is primarily by physical therapists and typically targets strengthening neck muscles, correcting muscle imbalances, regaining full range of movement, and improving postural control and symmetry. Treatment usually includes stretching, movement exercises, and positioning strategies.  If asymmetries and weakness are pronounced while using hands/arms and the baby is displaying oculomotor difficulties (coordinating eye movements) occupational therapy may be warranted as well.  Tummy time is an imperative piece in treating congenital muscular torticollis (CMT) and it can help to prevent acquired torticollis due to positioning restrictions.

 

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