Congenital muscular torticollis: Clinical features and diagnosis
- Charles G Macias, MD, MPH
Charles G Macias, MD, MPH
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Vanthaya Gan, MD
Vanthaya Gan, MD
- Clinical Professor of Pediatrics
- University of Texas Southwestern Medical Center
Torticollis is the term for the clinical finding of a twisted or rotated neck. In Latin, the word "tortus" means "twisted," and "collum" means "neck." Torticollis, also called wryneck, is a common complaint in children and may be congenital or acquired.
The clinical features and diagnosis of congenital muscular torticollis will be reviewed here. The management and prognosis of congenital muscular torticollis, acquired torticollis in children, and neck stiffness in children are discussed separately. (See "Congenital muscular torticollis: Management and prognosis" and "Acquired torticollis in children" and "Approach to neck stiffness in children".)
TERMINOLOGY AND CLASSIFICATION
●Congenital torticollis – Congenital torticollis is a postural deformity of the neck that develops prenatally (though presentation to medical attention may be delayed); congenital torticollis has muscular and nonmuscular causes (table 1). (See 'Differential diagnosis' below.)
●Congenital muscular torticollis – Congenital muscular torticollis is a postural deformity of the neck that is usually evident by two to four weeks of age; it is characterized by lateral neck flexion (head tilted to one side) and neck rotation (chin pointed to the opposite side) (picture 1).
There are three types, in order of increasing severity [1-3]:
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- TERMINOLOGY AND CLASSIFICATION
- CLINICAL FEATURES
- Physical examination
- Associated conditions
- Clinical diagnosis
- DIFFERENTIAL DIAGNOSIS
- Head tilt/postural preference
- Limited range of motion
- Neck mass
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS