![]() ![]() ![]() associated moderate to severe plagiocephalyĪ majority of cases will resolve after four to five months.a child older than 3 months at diagnosis with more than minimal torticollis.severe torticollis: limited ROM at diagnosis (e.g.no improvement with home exercises by 4–6 weeks.Consider referral to physiotherapy when there is:.GP follow up within 4 weeks for monitoring.Passive stretching exercises 4–5 times a day.Educate caregiver on infant positioning during feeding, sleeping and playing (including the importance of supervised prone positioning) and making environmental modifications to encourage head and neck movement.A hip US in infants with congenital muscular torticollis is recommended.A cervical spine X-ray may detect vertebral anomalies in atypical torticollis.If a mass is present but not characteristic of SCM, ultrasound (US) may be helpful.Routine neck imaging is not recommended.Rarely congenital torticollis may be secondary to vertebral anomalies, clavicle fractures, plagiocephaly, craniosynostosis, ocular pathology or CNS lesions.Note that Developmental Dysplasia of the Hip (DDH) is a common association and hips should be assessedĬonsider an alternative diagnosis if no muscle tightness or mass is palpated on examination.Eye movements, back and spine, upper and lower limbs and a neurological examination should be performed to identify rare non-muscular causes.Head shape and sutures (plagiocephaly and facial asymmetry are common).Palpate for tightening or SCM mass: the characteristic SCM mass is well circumscribed, firm and found in the inferior one-third of the affected SCM.Normal passive neck movements: when stabilised in the supine position, the examiner should be able to passively rotate the chin past the shoulders and laterally flex the neck so that the top of the ear touches the shoulder.Head position: the head and ear are tilted toward the affected SCM and the chin points to the opposite side.Delays appear to be more strongly related to infrequent prone positioning while awake and resolve by preschool age (3.5–5 years).Developmental milestones, especially gross motor, may be delayed.Time spent in prone position (lack of tummy time may contribute to persistence).Infants may have difficulty feeding on one side.Acute onset torticollis should prompt further investigation (see Acquired torticollis). ![]() Torticollis diagnosed after 6 months should prompt consideration of acquired causes (see Acquired torticollis).Onset: noticed at birth or shortly after supports diagnosis.Postural: infant has a preferred head posture but no muscle tightness or restriction to passive range of motionĬongenital muscular torticollis should be suspected in infants with a preferred head position or posture, reduced range of motion of the cervical spine, SCM mass, and/or craniofacial asymmetry.Muscular with SCM mass: Thickening of the SCM muscle and limitation of passive range of motion.Muscular: tightness of the sternocleidomastoid (SCM) muscle and limitation of passive range of motion.It is usually noted within the first month of life, however, diagnosis can be delayed More severe cases require referral to physiotherapy and rarely orthopaedicsĬongenital torticollis is a postural deformity of the neck that develops prenatally.Mild cases of congenital torticollis are managed at home by the care giver with simple stretching exercises.If the examination supports a diagnosis of congenital muscular torticollis, no further investigations are required Diagnosis after 6 months is rare and other causes should be considered Congenital torticollis is usually diagnosed within the first month of life. ![]()
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