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Congenital Muscular Torticollis

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Topic updated on 01/02/14 12:25am
Introduction
  • A congenital "packaging deformity" typically caused by contracture of the sternocleidomastoid (SCM) muscle
  • Epidemiology
    • found in infants
  • Pathophysiology
    • true etiology is unclear
    • some studies suggest association with intrauterine compartment syndrome of SCM muscle
    • non-SCM causes include
      • ophthalmologic
      • vestibular
      • congenital
      • traumatic
      • tumors
  • Associated conditions
    • often associated with other packaging disorders
      • DDH (5 - 20% association) 
      • metatarsus adductus 
    • traumatic delivery
    • plagiocephaly (head assymetry)
    • congenital atlanto-occipital abnormalities
Physical Exam
  • Symptoms
    • head tilt
      • usually noticed by parents
  • Physical exam
    • head tilt towards the affected side with chin rotation away from the affected side
    • palpable neck mass and fibrosis is noted within the first four weeks of life 
Imaging
  • Radiographs
    • indicated if no palpable mass present  to rule out other conditions that cause torticollis including
      • rotatory atlanto-axial instability
      • Klippel-Feil syndrome
  • Ultrasound
    • indicated in the presence of a palpable mass
    • can help differentiate congenital muscular torticollis from more serious underlying neurologic or osseous abnormalities 
Differential
  • Rotatory atlanto-axial instability / Grisel's disease 
    • Grisel's disease similar presentation but presents in older children
  • Klippel-Feil syndrome 
Treatment
  • Nonoperative
    • passive stretching
      • indications
        • condition present for less than 1 year
        • limitation less than 30°
      • stretching technique
        • should include lateral head tilt away from the affected side and chin rotation toward the affected side (opposite of the deformity) 
      • outcomes
        • 90% respond to passive stretching of the sternocleidomastoid in the first year of life
  • Operative
    • Z plasty lengthening or distal bipolar release of SCM
      • indications
        • condition present for greater than 1 year
        • limitation greater than 30°

 

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Qbank (2 Questions)

TAG
(OBQ10.218) A 6-week-old female infant presents with the neck deformity and palpable mass shown in Figure A. She has had persistent lateral tilting of her head to the right since birth, and rotation of the neck is restricted. In this age group, what is the most common cause of this rotational abnormality? Topic Review Topic
FIGURES: A          

1. Congenital muscular torticollis
2. Klippel-Feil syndrome
3. Arnold-Chiari malformation
4. Atlantoaxial rotatory displacement
5. Paroxysmal torticollis of infancy

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TAG
(OBQ09.2) Tightness in which of the following muscles has been implicated as an etiology for congenital muscular torticollis? Topic Review Topic

1. platysma
2. omohyoid
3. longus colli
4. sternocleidomastoid
5. trapezius

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