National University

Faculty Of Physiotherapy

Third Year - Semester - 6 - Batch (12)

Paediatrics Physiotherapy

Congenital muscular torticollis

Lana Satti Osman

0912456667

Definition

Congenital muscular torticollis also called twisted neck or wryneck, is a

condition in which an infant holds his head and neck tilted to one side and

the chin is rotated to opposite side. In CMT the muscle that extends goes

diagonally across the neck , the sternocleidomastoid muscle is tight and

shortened.

Types of muscular torticollis

1) Congenital torticollis

2) Acquired torticollis

Causes of congenital muscular

torticollis

The main cause is unknown however it may be related to:

1. Abnormal positioning ( breech position ) or “ crowding” of the baby while in the uterus.

2. Muscle trauma or injury during a difficult delivery.

3. Soft tissue compression in the neck due to positioning in the uterus.

4. Congenital abnormalities of soft tissues with in SCM muscle.

5. Abnormality of blood supply to the fetus.

Note: torticollis can be caused rarely by vertebral abnormalities (e.g. hemiatlas). The deformity is rigid and resists any passive correction.

Pathology:

Trauma …….. Bleeding into SCM muscle……….hematoma formation…………lead to scare

tissue formation………….. Replaced by fibrous tissue.

Intrauterine position of the head will make the muscle short and eventually fibroses.

Symptoms

1. The head tilts to one side and the chin points to the opposite shoulder. ( Rt

side is most affected).

2. Limited range of motion in the neck.

3. Small mass is usually present in the middle or lower third of the SCM

muscle. On palpation there is hard non tender, fusiform swelling or tumor

in SCM muscle.

Diagnosis

The diagnosis of torticollis is usually made by the pediatrician in the first 2 or

3 months of life when a pseudo tumor of SCM muscle, characteristic cord

like appearance of the muscle, abnormal head posture and restricted

cervical ROM.

Prognosis

CMT is not a life threatening condition. Early diagnosis is helpful and it

correct spontaneously. One of the complications that if not treated; might

develops is compression on the nerve roots.

Physiotherapy evaluation

1. History taking.

2. Observation.

a. Position of the head in relation to trunk and limbs.

b. The degree of the facial asymmetry by turning the head to mid position.

c. Inspection of the skin over the neck for folds asymmetry.

d. Observation of the infants abilities “ age appropriate motor skills”.

e. Postural assessment for the entire spine.

3. Palpation

4. PROM & AROM.

5. Asymmetrical or abnormal reflexes should be tested.

6. Measuring the size of the tumor.

7. Lower extremities should be examined for hip dislocation and other associated problems . There is 20% incidence of hip dislocation in children with torticollis.

Physiotherapy goals

1. Stretch the tight muscles.

2. Strengthen the contralateral SCM muscle and neck muscles.

3. Prevent development of contracture.

4. Prevent delay of normal neck activities.

5. Encourage normal posture.

6. Facilitate normal righting reactions.

Physiotherapy treatment

Treatment should start as soon as the diagnosis is made. The treatment

consist of the following:

1. Positioning

2. Gentle PROM

3. Strengthen exercises

4. Stretching exercise

5. Facilitation of the age appropriate skills

6. Orthotics

7. Home routine

Surgical treatment

Surgical release of the SCM muscle is required when:

1. When children don’t respond to conservative treatment within one year.

2. In neglected cases until the age of one year.

3. When the parents haven't complied in performing an effective exercise

regimen.

Post operative PT management:

1. Immediately after surgery child lies without pillow, sand bag is used to

prevent returning of the head.

2. Stretching starts after 36 hours from surgery.

3. Strengthen exercise and

4. orthosis may be prescribed.

Cap and jacket splint Tubular orthosis