Congenital muscular torticollis: Management and prognosis
- 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 management and prognosis of congenital muscular torticollis will be reviewed here. The clinical features and diagnosis of congenital muscular torticollis, acquired torticollis in children, and neck stiffness in children are discussed separately. (See "Congenital muscular torticollis: Clinical features and diagnosis" and "Acquired torticollis in children" and "Approach to neck stiffness in children".)
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]:
●Postural – Infant has a postural preference but no muscle tightness or restriction to passive range of motion
●Muscular – Tightness of the sternocleidomastoid muscle and limitation of passive range of motion
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- NATURAL HISTORY
- GENERAL PRINCIPLES
- INDICATIONS FOR REFERRAL
- Physical therapy
- Other specialists
- FIRST-LINE INTERVENTIONS
- Positioning and handling
- Environmental adaptations
- Passive stretching
- Facilitation of active movements
- ADJUNCTIVE INTERVENTIONS
- RESPONSE TO THERAPY
- MANAGEMENT OF REFRACTORY TORTICOLLIS
- - Surgery
- - Botulinum toxin
- LONG-TERM FOLLOW-UP
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS