Torticollis
Torticollis is a disorder of the neck where the neck is rotated, flexed, side bent or extended beyond the normal resting position of the neck. The sternocleidomastoid or SCM muscle is in an involuntary spasm causing this malposition.
Torticollis can either be congenital, from birth, or acute usually caused by an injury.
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.
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.
How is it treated?
Congenital torticollis is treated through exercises that stretch
your baby's neck. Your physical therapist can 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.
Acute Torticollis
Acute torticollis can occur from any neck injury. Some patients say they "slept wrong" when upon waking they have difficulty moving their neck secondary to pain or tightness of the muscles in the neck and upper back.
How is it treated?
It is important to be evaluated by a trained medical professional comfortable with evaluating and treating the neck. Many physical therapists are specially trained to evaluate the structures of the neck and determine a possible biomechanical and neuromyofascial diagnosis.
Rarely does this diagnosis need more than 6-8 session of manual physical therapy complemented with specific strengthening and stretching exercises that your physical therapist can prescribe.
At times it will be important to receive an x-ray or MRI to rule-out other causes especially when trauma was involved in the onset of acute torticollis.
