Torticollis

Congenital Muscular Torticollis (CMT), also known as torticollis, is a condition in which your baby prefers to tilt and/or turn his/her head to one side as a result of a muscle strain to one of the main neck muscles, the sternocleidomastoid (SCM). In the majority of cases, this muscle is tight and/or weak causing your baby’s head to tilt to one side and/or turn to the opposite side.

Congenital refers to a condition that is present at birth. The term "torticollis" refers to "twisted neck or wry neck". CMT can be identified as early as in newborns or during the first few months of life depending on the severity of the infant's positional head preference.

In some cases, torticollis can develop after the birth of a baby if the baby is not repositioned adequately and appropriately to prevent tightening of the muscles in the neck.

CMT is the third most common congenital musculoskeletal condition. Research suggests that the incidence of CMT is 16% and in a 2008 United States study researchers identified as many as 1/6 newborns with CMT.

CMT is the number one condition associated with plagiocephaly. 70-80% of babies with plagiocephaly have CMT.

• Baby prefers to tilt and/or turn his/her head to one side
• Thickening and tightness of the SCM and/or other neck muscles
• Decreased neck range of motion to the opposite side
• Decreased neck strength
• Small, palpable mass (size of a small pea), known as a fibromatous coli or SCM tumor
  Typically 1-3 cm in size Palpable at 2 to 4 weeks of age Fibrotic mass goes away by 6 months of age
• Plagiocephaly (asymmetrical flattening most noticeable on the back and/or side of the head with frontal bone forward shifting on the same side)
• Asymmetrical facial features (e.g. eye, ear, or cheek can be smaller or shifted forward, jaw can be shifted towards one side)
• Redness and/or skin breakdown within the neck creases on the affected side
• Poor tolerance with tummy time

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The most common presentation of CMT is when a baby prefers to tilt his/her head to one side and turn to the opposite side. For example, this baby prefers to tilt his head to his RIGHT and turn his head to his LEFT. However, depending on the degree of muscular involvement, some babies may present with just a turning preference or a tilting preference

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• Signs and symptoms will vary depending on the severity of CMT.
• The severity of a baby's postural head preference is determined by whether the baby has muscle stiffness, muscle weakness, or both.
• It can vary throughout the day, but postural preference is most noticeable when the baby is resting, tired, irritable/fussy, or hungry.

CMT is primarily due to an in-utero positioning problem. The exact mechanism of injury is unknown however, research suggests there is an injury to the infant's sternocleidomastoid muscle (SCM), similar to a muscle strain, which results in temporary decreased blood flow to the muscle. As part of the SCM's healing process, scar tissue develops within the muscle fibers. This can occur to the baby in-utero or during birth.

In very rare cases, CMT is caused by an ocular nerve injury, cervical spinal abnormalities, or genetic conditions

Risk Factors Associated with CMT

• Multiples birth (e.g., twins, triplets)
• Non-vertex presention (e.g., breech position, sunny-side up position)
• Complicated labor and delivery (e.g., prolonged labor, vacuum or forceps delivery assist)
• Increased birth weight and/or increased birth length
• Maternal uterine abnormalities (e.g., fibroid tumors, low amniotic fluid, small pelvis for baby's size)
• Other congenital conditions (e.g., hip dysplasia, club foot, metatarsus adductus, brachial plexus injury)