Torticollis comes from two Latin root words, “tortus” and “collum”, which together mean “twisted neck”. A child with Torticollis presents with his or her head tilted towards one side, with chin turned in the opposite direction.
Technically speaking, Torticollis in children causes a lateral flexion contracture of the cervical spine musculature, specifically the Sternocleidomastoid (SCM) muscle. The SCM’s main function is to rotate the head to the opposite side and flex the neck. When acting together both left and right SCMs work to flex the neck and extend the head. When acting alone, each SCM muscle rotates head to the opposite side while laterally flexing head to the same side.
In general, Torticollis is classified as either congenital (present at birth) or acquired (occurring later in infancy or childhood). Torticollis can also be caused, albeit rarely, by bony deformities in the spine, vision problems (Ocular Torticollis), or neurological imbalances (Benign Paroxysmal Torticollis). Congenital Muscular Torticollis (CMT) is, by far, the most commonly diagnosed in infants.
Causes of CMT include: abnormal positioning or lack of space in utero, multiple gestations (can lead to tight quarters!), low amniotic fluid, and/or a traumatic birth process. Over time the SCM muscle gets shortened, developing contractures and requires intervention in order to lengthen the muscle and reverse any discrepancies in alignment or strength that resulted from this muscular imbalance.
- Head tilt to the side of the tight muscle, with the chin turned toward the opposite side.
- Palpable lump in the muscle belly on the shortened side.
- Limitations in range of motion, difficulty turning head with gaze side to side and looking up and down.
- If breastfed, difficulties breastfeeding on one side (or seems to prefer one breast only).
- Favoring of one side during active play.
- Rolling towards one direction only.
- Displays of frustration or wincing when attempts are made to turn head to opposite side.
- Lack of response when visual, auditory and/or tactile stimulus is applied to involved side.
These signs may go unnoticed until children are several weeks or even months old. As the child starts to gain more control of his or her head movements, and families notice a strong preference to look, turn, and play more on one side with an accompanying restriction in head rotation or lateral flexion.
Once a parent or caregiver becomes concerned it is very important to act quickly so that the child can get the proper care and treatment. In general torticollis responds very well to Physical Therapy intervention, when part of a comprehensive treatment protocol that includes passive positioning, active stretching, therapeutic exercise, proper handling and environmental modifications where needed. It truly is a team effort requiring participation of the family to carry over exercise and activity recommendations to ensure the best possible outcomes!
- Plagiocephaly or a flattening of the skull causing asymmetry in the shape of the head and face.
- Developmental hip dysplasia
- Unilateral movement that favors one side of the body, affecting the arms, trunk and hips. This can lead to postural shifts, as well as balance and strength deficits.
- Limited ability to turn the head to see, hear and interact with surroundings which can impact cognitive development.
- Delays in motor milestone acquisition.
The diagnosis of CMT is usually made upon physical examination, within the first few months of child’s life. Differential diagnosis includes: non-muscular origins of the presentation such as Klippel-Feil Syndrome (a fusion of the cervical vertebrae), scoliosis, brachial plexus injury, ocular damage of other congenital neurologic conditions.
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