Article
Congenital Muscular Torticollis
Introduction
• Congenital anomaly
• Intrauterine compartment syndrome of Sternocleidomastoid leading to fibrosis and
contracture
Clinical Features
• Look : at birth SCM tumor –hematoma,Taut muscle on rotation ,opp lateral bending
Facial asymmetry –plagiocephaly , Associated anomaly – DDH … look for it pro actively
• Feel : tight band of SCM
• Movements : restricted lateral bending and rotation on one side .
• Measure : shortening of muscle in neutral position of head
Differential Diagnosis :
• if painful ,rule out infection,inflammatory,trauma ,TB spine , Rotary subluxation,Rheumatoid
arthritis
• If Taut muscle not palpable ,movements free ,painless -non muscular causes: Ocular,
neurological (dystonia), OC2 upper cervical bony anomaly
Investigations : Plain X-ray Cervical spine … usually normal
CT/MRI if non muscular causes or painful torticollis only
Treatment :
• Active and passive stretching exercises. TOT (Tubular Orthosis for Torticollis)collar
• 80% resolve by 2 years …
• Surgery if indicated after 3 years .. ideal age 3-5 yrs
• Older children can be operated …no upper age limit (references to be given )… result may be
poorer
• Options :
• Unipolar release
• Bipolar release – Ferkels method …commonly done
OrthoPed 