Congenital Muscular Torticollis

Abstract

Congenital muscular torticollis (CMT) is one of the most common congenital musculoskeletal conditions. It is observed in infancy and characterized by a persistent head tilt toward the involved side with the chin rotated to the contralateral shoulder due to the shortening or fibrosis of the involved sternocleidomastoid muscle. The incidence of CMT has been on the rise and is reported in between 3.9% and 16% of infants. It is often accompanied by cranial deformation, and less frequently by developmental dysplasia of the hip, club foot, and metatarsus adductus. Carefully analyzing possible differential diagnoses by attaining a thorough medical history and a clinical exam are imperative to make the correct diagnosis as up to 18% of children presenting with a sign of torticollis will have a diagnosis other than CMT. Infants with CMT benefit from early diagnosis and expeditious referral to pediatric physical therapy resulting in better outcomes and shorter treatment durations. Physical therapy treatment consists of passive cervical stretches, neck and trunk active ranges of motion, facilitation of symmetrical motor skill development, environmental adaptations, and caregivers’ education. Physical therapy management of CMT, especially when cases are identified early and treatment is initiated immediately, can achieve excellent outcomes in 90–99% of cases, and only in rare instances, surgical release of the SCM muscle is necessary.