Definition

Torticollis, commonly known as wryneck, is a condition where the neck muscles twist, causing a child's neck to appear twisted to one side. This condition is commonly seen in infants and children. Due to the neck being twisted at an unusual angle, the child's chin and the top of the head will be misaligned and not in a straight line.

Torticollis is divided into two types according to its onset: congenital torticollis (present at birth) and acquired torticollis. If left untreated, torticollis can cause pain and difficulties in performing daily activities. Fortunately, available treatments and therapies can help reduce muscle stiffness and pain. In some cases, surgery may be recommended to correct the condition, especially in children, where early intervention increases the success rate of treatment.

Causes

Congenital Torticollis

Torticollis that is present from birth is believed to be caused by injury to the soft tissues of the neck before or during childbirth. One of the neck muscles, the SCM (sternocleidomastoid muscle), becomes shortened on one side. While the exact cause of this shortening is unknown, some possible theories include:

• The baby's position in the womb was less than ideal, leading to a difficult delivery or the need for assisted tools like forceps
• The neck muscle developed abnormally or became thickened
• A blood clot in the baby's neck muscle caused the muscle to tighten or shorten
• Klippel-Feil syndrome, a rare congenital disorder that causes the bones in a baby’s neck to fuse
• A clavicle fracture during delivery

Acquired Torticollis

This type of torticollis may appear within the first 4-6 months of life or later in childhood. It can occur due to swelling in the child’s throat, which loosens the tissues around the upper spine. In rare cases, the neck vertebrae may shift slightly out of position.

Other causes of acquired torticollis include:

• Trauma or injury to the head or neck
• Neck wounds, such as burns, that result in scar tissue and muscle shortening
• Neck muscle inflammation that leads to spasms, causing the head to twist to one side
• Secondary effects of medical conditions such as stroke, rheumatologic diseases or neck tumors, or as a side effect of medication
• Upper respiratory tract infections and soft tissue infections of the neck

Risk Factor

Factors that increase the risk of torticollis include:

• Difficult deliveries, such as the use of forceps or vacuum assistance
• A history of head or neck injury
• Abnormal fetal positioning in the womb, such as breech presentation, where the baby’s head is at the top and the lower body is in the birth canal
• A family history of torticollis

If you are interested in reading an article about fetal malposition, you can read it here: Malpresentation—Definition, Causes and Risk Factors.

Symptoms

In infants, parents may not notice anything unusual in the first 6-8 weeks of life. As the baby grows, torticollis may become more noticeable.

Symptoms of torticollis include:

• The baby's head is turned to one side, and the chin is pointing in the opposite direction
• The baby has difficulty moving their head or neck
• One shoulder appears higher than the other
• The neck is stiff and may appear swollen
• The baby maty experience breastfeeding difficulty on one side due to the position of their head

In addition to these symptoms, other issues may arise depending on the underlying cause of the torticollis, such as:

• Signs of infection, such as fever
• Neurological or eye problems such as headaches, tremors, vomiting, dizziness, or vision changes

Diagnosis

As with other medical conditions, diagnosing torticollis involves medical history, physical examination, and additional tests.

Medical History

During the medical interview, the doctor may ask parents about:

• The primary concerns and any accompanying symptoms
• The duration and onset of the symptoms
• The mother’s pregnancy and delivery history
• Any history of injury and how it occurred
• Any previous treatments
• The child’s past medical history and family medical history

Physical Examination

During a physical exam, the doctor will assess the general condition of the child, examining the head position and body posture. The neck will be checked for restricted movement, swelling, lumps, or muscle stiffness. In many cases, torticollis is apparent from a physical examination alone.

Diagnostic Tests

Depending on the severity or association with other medical conditions, the doctor may recommend additional tests such as neck X-rays, CT scans of the head and neck, or an MRI.

Management

Treatment for torticollis aims to address the underlying cause and restore the child to a normal condition. Options may include medication, physical therapy, or surgery.

Often, stretching exercises and repositioning can correct congenital torticollis. Medical professionals can teach parents how to properly position the baby's head while lying down and perform neck muscle stretches. The goal is to gradually turn the baby’s head to the opposite side, and these exercises can be done several times a day.

If these measures are ineffective, the doctor may refer the child to specialists for physical therapy. Physical therapy options include stretching exercises, massage, applying heat to specific areas, or electrical nerve stimulation (TENS).

The choice of treatment depends on:

• The child's age and overall health
• The severity of the torticollis
• The child’s tolerance to medications, procedures, or therapies
• Parental preferences regarding treatment methods

Complications

If your child has torticollis, possible complications include:

• Deformities in the face and neck area may worsen due to limited muscle movement
• Plagiocephaly, also known as flat head syndrome. The skull of a newborn is soft and pliable; thus, if the head remains in a fixed position for an extended period, specific areas may become asymmetrical and exhibit flattening

Prevention

There is no specific way to prevent torticollis. However, regular prenatal check-ups can help monitor the condition of both mother and baby. Routine pregnancy exams can also detect risk factors that may complicate delivery.

When to See a Doctor?

Consult a doctor if your child is unable to turn their head, has a twisted neck, or if the shoulders appear uneven. Torticollis should also be addressed if it occurs in older children. It is best to start with a pediatrician for further consultation.

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