What is congenital torticollis?

By Cristiano Antonino On Jun 25, 2023

Torticollis is a pathological condition characterized by a lateral or rotational deviation of the head. Although many people suffer from this pathology, especially as they get older, perhaps few will know that it can also be congenital

While acquired torticollis can arise due to a number of different factors, from scarring of muscle tissue to enlarged lymph nodes, congenital torticollis is caused by developmental abnormalities resulting in an excessively short sternocleidomastoid muscle. and tense.

Although it is difficult to diagnose, especially in the very first days of the newborn’s life, it is very important to treat and correct the spoiled attitude as soon as possible to have an optimal prognosis.

What is congenital torticollis?

Congenital torticollis is a malformation condition present at birth characterized by a permanent incorrect attitude of the head and neck accompanied by difficulty or impossibility to perform some usually physiological movements.

Congenital torticollis is in turn divided into torticollis due to congenital developmental anomalies, called osteogenic, and congenital muscular torticollis, called myogenic, depending on the anatomical structures affected by the malformation: the vertebral column, in the first case, the neck muscles it concerns the second.

Either way, identifying a congenital torticollis isn’t easy.

Usually, it is the parents who notice that something is wrong with the child’s posture during the first few weeks of life.

Now let’s see in more detail what osteogenic and myogenic congenital torticollis consist of and how they differ.

Osteogenic congenital torticollis

As the prefix suggests, congenital osteogenic torticollis is due to bone malformations affecting the cervical vertebrae.

These morphological anomalies of the spine include:

Atlanto-occipital synostosis, i.e. the fusion of the first two cervical vertebrae.
Klipper-Feil syndrome, a rare musculoskeletal disorder that can lead to narrowing of two or even more cervical vertebrae.
Hemispondylia, a congenital malformation of the spine which consists in the failure of one half of the vertebral body to develop.
Cervical spina bifida, a birth defect due to incomplete fusion of one or more vertebrae.

Congenital osteogenic torticollis is much more difficult to diagnose at birth than myogenic one since it is a type of disorder that has an extremely slow evolution even if it is progressive.

Usually, the clinical picture is evident in the patient between the ages of 10 and 20 years.

This type of torticollis can cause the patient problems such as: shortness of the neck, cervical scoliosis, movement limitations, lateral deviation of the neck and brachialgia, a form of neuralgia characterized by severe pain in the arm caused by the crushing of a peripheral nerve at the level of the neck.

Congenital myogenic torticollis

Myogenic torticollis is considered among the most frequent forms of congenital torticollis and is caused by unilateral fibrous retraction of the sternocleidomastoid muscle which is therefore decreased in length and of increased consistency.

Lateral tilt of the head is evident in children with congenital myogenic torticollis, associated with rotation of the face to the opposite side and craniofacial asymmetry.

Unlike congenital osteogenic torticollis, myogenic torticollis is usually diagnosed faster, even if the disorder is rarely detected in the first days of the patient’s life.

Generally, it is the parents who notice the child’s tendency to always keep his head turned towards the same side and the scarce tendency to turn his head towards the opposite side.

In this case the clinical picture is evident within 3 months of birth.

What is the sternocleidomastoid muscle?

The sternocleidomastoid, often abbreviated to SCM or SCOM, is a large neck muscle located on its anterior and lateral sides.

It is present on both sides and originates from two heads: the sternal head and the clavicular head.

The former originates from the manubrium of the sternum while the clavicular one originates from the upper surface of the clavicle.

Both heads unite in a single tendon which inserts on the mastoid process, at the level of the temporal bone of the skull.

When the sternocleidomastoid muscle contracts on one side only, it allows the head to rotate to the opposite side, tilt the head to the same side, or extend it.

If, on the other hand, both muscles are activated, they allow you to: flex the neck having the chest as a fixed point or, if the fixed point is the head, to lift the chest. In the latter case the SCOM muscle has the function of inspiratory muscle.

What are the causes of congenital torticollis?

The causes that lead to the origin of congenital torticollis are still unknown.

However, over time, various theories have been formulated to explain this malformation.

The most accredited is the mechanical theory which hypothesizes that the cause of congenital torticollis is linked to an incorrect position of the child inside the uterus.

A hypothesis that seems confirmed by the fact that congenital torticollis seems to be more common in firstborns, given that they have less space inside the maternal uterus.

How to recognize the symptoms of a congenital torticollis in a newborn?

As already mentioned above, the main symptom of a congenital torticollis is the position of the newborn’s head, which tends to be inclined to one side only with the chin facing the opposite shoulder.

Furthermore, in the case of myogenic torticollis, a soft protuberance in the baby’s neck may be felt in the first weeks of birth, which tends to gradually disappear.

Active and passive range of motion is then reduced and, moreover, due to the fact that the child with congenital torticollis always sleeps on the same side, one side of the face may be flattened.

Other symptoms of a congenital torticollis can be:

Plagiocephaly, that is, an asymmetry of the skull.
Plagioprosopia, a facial asymmetry with oblique eye and lip lines.
Facial scoliosis, with the midline of the face concave towards the side affected by the lesion.

How is congenital torticollis diagnosed?

Given the suspicion of the presence of a congenital torticollis, the diagnosis must be confirmed by a visit to the paediatrician, orthopedist or child physiatrist.

In addition to the physical examination, the specialist will be able to make use of the help of some instrumental diagnostic techniques such as ultrasound, totally painless for the young patient and very reliable for the doctor.

Furthermore, in the case of suspected osteogenic congenital torticollis, a computed tomography (CT) scan may be required in order to better analyze the upper cervical tract.

In the analysis of possible differential diagnoses, it will be the task of the specialized doctor to understand which form of congenital torticollis it is and to exclude any forms of symptomatic torticollis of inflammatory, neurological, traumatic origin, etc.

Only after making a correct diagnosis will the specialist be able to prescribe the most suitable treatment for the case.

What are the possible treatments to cure the disease?

The treatments vary not only according to the type of congenital torticollis, but also considering the level of severity of the malformation.

As far as congenital bone torticollis is concerned, the most suitable therapy involves the use of specific corrective plaster casts or orthopedic braces.

In the most serious cases, to prevent the pathology from progressing, it is necessary to intervene on the affected segment with surgery.

In the case of congenital myogenic torticollis, on the other hand, the treatment usually prescribed is physiotherapy.

For a favorable prognosis it is very important to entrust the child to the care of an expert physiotherapist, who will draw up a program to be followed to correct the malformation.

The aim of physiotherapy treatment is to lengthen the sternocleidomastoid muscle which is shorter.

In infants and young children, this is achieved with passive stretching, i.e. trying to gently correct the deformity in the opposite direction by tilting the head towards the shoulder opposite the injury and turning the chin, always towards the opposite shoulder .

Physiotherapy sessions are usually prescribed 3-4 times a week, however the collaboration of parents is also very important, who will have to take care to have the child perform the exercises every day and help him to assume postures that spontaneously favor the stretching of the sternocleidomastoid muscle .

Treatment is usually successful and surgery is rarely required.

In milder cases, improvements begin to be evident a few days after the start of therapy.

However, as the child grows, the condition may recur in some cases, for example when the child is particularly tired or after acquiring a new anti-gravity posture.

These phenomena must be kept under control, but should disappear during growth.

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