Congenital Torticollis

Topic Overview

What is congenital torticollis?

Torticollis, also known as "wryneck," is a condition in which your baby's head is tilted. The chin points to one shoulder, while the head tilts toward the opposite shoulder. Treatment is necessary to prevent your baby's face and skull from growing unevenly and to prevent limited motion of the head and neck.

"Congenital" means a condition that is present at birth. Congenital torticollis occurs at or shortly after birth.

See an illustration of congenital torticollis .

What causes congenital torticollis?

Congenital torticollis occurs when the neck muscle that runs up and toward the back of your baby's neck (sternocleidomastoid muscle) is shortened. This brings your baby's head down and to one side. This is known as congenital muscular torticollis.

Experts don't know what causes the shortened neck muscle. Some experts believe that the muscle may sometimes be stretched or torn during the baby's birth. The tear causes bleeding and swelling, and scar tissue replaces some of the muscle, making it shorter.

Some cases of congenital torticollis are caused by a bone problem in the neck portion of the spine (cervical spine). This is known as a congenital malformation of the cervical spine.

Torticollis may also occur later in life; however, this is not congenital torticollis.

What are the symptoms?

Your baby's head is tilted to one side. The chin points to one shoulder, while the head tilts toward the opposite shoulder. Usually, the head tilts to the right and the chin points left, meaning the muscle on the right side is affected. You may notice that your baby cannot move his or her head as well as other babies. You may also notice a lump in your baby's neck muscle.

How is congenital torticollis diagnosed?

The caregiver usually first notices that the infant always holds his or her head tilted to one side. It is important to see your health professional for an examination, because other conditions may also cause this head position.

Your health professional will examine your baby and may ask you questions about your baby's birth. He or she may want an X-ray of the cervical spine to rule out bone problems.

Your health professional may also check your baby's hips. An abnormal development of the hip (hip dysplasia) is present in 1 out of 5 infants with congenital torticollis.¹

How is it treated?

Congenital torticollis is treated through exercises that stretch your baby's neck. Your health professional or a physical therapist will teach you how to do them with your baby, and then you will stretch your baby's neck on your own several times a day.

You can also play with your baby in ways that stretch the neck. Placing toys and other objects in positions where your baby has to turn his or her head to see them helps stretch the muscle.

If your baby does not improve after 2 to 3 months of stretching, contact your health professional. There may be another problem, or surgery may be necessary to stretch or lengthen the neck muscle.

The lump in the muscle usually goes away on its own.

If the congenital torticollis is not caused by a shortened neck muscle but by a cervical spine abnormality, the spine abnormality is sometimes treatable.

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Author:	Kathe Gallagher, MSW	Last Updated August 30, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Thomas S. Renshaw, MD - Orthopedics
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