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Congenital muscular torticollis

Definition
Congenital muscular torticollis is a benign congenital musculoskeletal disorder characterized by unilateral shortening of the sternocleidomastoid muscle that leads to ipsilateral head tilt and contralateral rotation of the face and chin.
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Pathophysiology
The exact cause of congenital muscular torticollis is still unknown; however, several theories have been proposed including intrauterine crowding, muscle trauma during a difficult delivery, soft tissue compression leading to compartment syndrome, and congenital abnormalities of soft tissue differentiation within the sternocleidomastoid muscle.
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Disease course
Clinical manifestations include ipsilateral head tilt and contralateral rotation of the face and chin, plagiocephaly, palpable pseudotumor, and tightness of the muscle. Untreated congenital muscular torticollis in infancy may lead to craniofacial growth deformity in adults.
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Prognosis and risk of recurrence
Congenital muscular torticollis is not associated with increased mortality.
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Key sources
The following summarized guidelines for the evaluation and management of congenital muscular torticollis are prepared by our editorial team based on guidelines from the American Physical Therapy Association (APTA 2013).
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Guidelines

1.Screening and diagnosis

Differential diagnosis: perform a screening examination of the neurological, musculoskeletal, integumentary, and cardiopulmonary systems (including evaluation of positional preference, structural integrity of the musculoskeletal system and movement symmetry) when a clinician, parent, or caretaker indicates concern about head or neck posture and/or developmental progression.
B
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2.Classification and risk stratification

Severity classification: grade the severity of congenital muscular torticollis according to a 7-grade rating scale.
B

3.Diagnostic investigations

Physical examination: assess for the presence of neck and/or facial or cranial asymmetry within the first 2 days of birth, using passive cervical rotation, passive lateral flexion, and/or visual observation.
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  • Clinical history

4.Nonpharmacologic interventions

Physical therapy interventions: address at least these 5 components in the physical therapy plan of care for the infant with congenital muscular torticollis or postural asymmetry:
neck passive ROM
neck and trunk active ROM
development of symmetrical movement
environmental adaptations
parent/caregiver education
B

5.Patient education

General counseling: determine the prognosis for resolution of congenital muscular torticollis and the episode of care after completion of the evaluation, and communicate it to the parents/caregivers.
B

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  • Documentation

6.Follow-up and surveillance

Indications for specialist referral: refer infants identified as having positional preference, reduced cervical ROM, sternocleidomastoid masses, facial asymmetry and/or plagiocephaly to the primary pediatrician and a physical therapist as soon as the asymmetry is noted.
B

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  • Serial clinical assessment