SUMMARY Congenital Muscular Torticollis is a musculoskeletal deformity caused by the abnormal contraction of the sternocleidomastoid muscle. The condition typically presents in infants and children with a persistent head tilt toward the involved side. Diagnosis is made clinically with the presence of a palpable neck mass from a contracted sternocleidomastoid muscle with the chin rotated towards the contralateral side. Treatment is typically passive stretching with the condition resolving within a year. Surgical lengthening of the SCM muscle is indicated with failed response to at least 1 year of stretching. Epidemiology Incidence most common cause of infantile torticollis 0.3 - 2.0% Demographics 3:2 male to female ratio Anatomic location neck Risk factors oligohydramnios first pregnancy (limited intrauterine space) traumatic delivery breech delivery Etiology Pathophysiology contracture of the sternocleidomastoid (SCM) login to view 1 more bullet suspected muscle injury from compression and stretching of SCM venous outflow obstruction login to view 1 more bullet Associated conditions associated with other packaging disorders login to view 3 more bullets plagiocephaly (asymmetric flattening of the skull) login to view 1 more bullet congenital atlanto-occipital abnormalities ANATOMY Muscles sternocleidomastoid muscle (SCM) login to view 11 more bullets PRESENTATION Symptoms head tilt and rotation painless passive motion Physical exam inspection login to view 8 more bullets motion login to view 2 more bullets IMAGING Radiographs recommended views login to view 1 more bullet indications login to view 2 more bullets CT recommended views login to view 2 more bullets indications login to view 1 more bullet MRI recommended views login to view 1 more bullet indications login to view 1 more bullet Ultrasound indications login to view 1 more bullet findings login to view 2 more bullets DIFFERENTIAL Atlantoaxial rotatory subluxation painful (compared to painless for congenital muscular torticollis) post-traumatic or post-infectious (Grisel's disease) Klippel-Feil syndrome classic triad: login to view 3 more bullets Ophthalmologic and vestibular conditions Lesions of central and peripheral nervous system TREATMENT Nonoperative passive stretching login to view 5 more bullets Operative bipolar release of SCM or Z-lengthening login to view 5 more bullets TECHNIQUES Passive stretching technique login to view 3 more bullets Bipolar release of SCM or Z-lengthening technique login to view 2 more bullets complications login to view 1 more bullet COMPLICATIONS Permanent rotational deformity risk factors login to view 1 more bullet Positional plagiocephaly risk factors login to view 1 more bullet Craniofacial deformities facial asymmetry facial hemihypoplasia Compensatory scoliosis Prognosis Typically resolves with stretching within the first year If left untreated permanent rotational deformity positional plagiocephaly craniofacial deformities login to view 2 more bullets compensatory scoliosis