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Congenital Torticollis

Topic Overview

What is congenital torticollis?

Torticollis, also known as "wryneck," is a condition in which your baby's head is tilted. The chin points to one shoulder, while the head tilts toward the opposite shoulder. Treatment is necessary to prevent your baby's face and skull from growing unevenly and to prevent limited motion of the head and neck.

"Congenital" means a condition that is present at birth. Congenital torticollis occurs at or shortly after birth.

See a picture of congenital torticollis.

What causes congenital torticollis?

Congenital torticollis occurs when the neck muscle that runs up and toward the back of your baby's neck (sternocleidomastoid muscle) is shortened. This brings your baby's head down and to one side. This is known as congenital muscular torticollis.

Experts don't know exactly what causes the shortened neck muscle. The muscle may get injured before or during the baby's birth. The injured muscle may bleed and swell. And scar tissue may replace some of the muscle, making it shorter.

Some cases of congenital torticollis are caused by a bone problem in the neck portion of the spine(cervical spine). This is known as a congenital malformation of the cervical spine.

Torticollis may also occur later in life, but this is not congenital torticollis.

What are the symptoms?

Your baby's head is tilted to one side. The chin points to one shoulder, and the head tilts toward the opposite shoulder. Usually the head tilts to the right and the chin points left, meaning the muscle on the right side is affected. You may notice that your baby cannot move his or her head as well as other babies. You may also notice a lump in your baby's neck muscle.

How is congenital torticollis diagnosed?

The caregiver usually first notices that the infant always holds his or her head tilted to one side. Be sure to see your doctor for an exam, because other conditions may also cause this head position.

Your doctor will examine your baby and may ask you questions about your baby's birth. He or she may want an X-ray of the cervical spine to rule out bone problems.

Your doctor may also check your baby's hips. Some babies who have congenital torticollis also have an abnormal development of the hip (hip dysplasia).

How is it treated?

To treat congenital torticollis, you'll learn to stretch your baby's tight neck muscle several times a day. Your doctor or a physical therapist will teach you how to safely do the exercises.

Another way to help you stretch your baby's neck is to do things so that he or she rotates the chin toward the shoulder of the affected side. For example:

  • During feeding, hold your child in a way that makes him or her rotate the chin to the correct position.
  • Place the crib so that your child turns his or her chin the correct way in order to see the room.
  • Place toys and other objects in such a way that your baby has to turn his or her head to see them and play with them.

If your baby does not improve after a few months of stretching, contact your doctor. There may be another problem, or surgery may be needed to stretch or lengthen the neck muscle.

The lump in the muscle usually goes away on its own.

If the congenital torticollis is not caused by a shortened neck muscle but by a cervical spine abnormality, the spine abnormality is sometimes treatable.

References

Other Works Consulted

  • Loder RT (2006). The cervical spine. In RT Morrissy, SL Weinstein, eds., Lovell and Winter's Pediatric Orthopaedics, 6th ed., vol. 2, pp. 871–919. Philadelphia: Lippincott Williams and Wilkins.
  • Mercier LR (2008). The cervical spine. In Practical Orthopedics, 6th ed., pp. 29–43. Philadelphia: Mosby.
  • Staheli LT (2006). Upper limb. In Practice of Pediatric Orthopedics, 2nd ed., pp. 227–240. Philadelphia: Lippincott Williams and Wilkins.

Credits

ByHealthwise Staff
Primary Medical ReviewerJohn Pope, MD, MPH - Pediatrics
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical ReviewerRobert B. Keller, MD - Orthopedics

Current as ofNovember 29, 2017


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