Congenital muscular torticollis is a condition in which an infant's neck muscle is shortened causing the neck to twist. Congenital means present at birth and torticollis means twisted neck. The condition is sometimes called "wryneck."
Congenital muscular torticollis may occur following a difficult birth, especially if the infant is very large or is delivered breech. During the delivery, if the sternocleidomastoid muscle, the neck muscle that extends from the jawbone (mastoid) to the clavicle (collarbone) and sternum (breastbone), is stretched or pulled, it may tear, causing bleeding and bruising within the muscle. The injured muscle develops fibrosis (scar tissue) which causes the muscle to shorten and tighten, pulling the infant's head to one side. The fibrosis forms a mass or lump that sometimes can be felt on the side of the neck.
Occasionally, congenital muscular torticollis occurs because of a defect in the development of the sternocleidomastoid muscle, or because of an abnormal fetal position in the uterus.
Congenital muscular torticollis may be visible at birth or it may not become evident until several weeks later. The following are the most common symptoms of congenital muscular torticollis. However, each child may experience symptoms differently. Symptoms may include:
The symptoms of congenital muscular torticollis may resemble other neck masses or medical problems. Always consult your child's physician for a diagnosis.
Generally, physical examination of the infant may show the characteristic tilting of the head and tension of the sternocleidomastoid muscle, as well as presence of a mass in the middle portion of the muscle. In addition to a complete medical history and physical examination, diagnostic procedures for congenital muscular torticollis may include the following:
If the condition is not corrected, the infant will be unable to move his/her head properly. Permanent muscle tightening with asymmetry (uneven development) of the neck and face can result. Specific treatment of congenital muscular torticollis will be determined by your child's physician based on:
Treatment may include:
The neck mass may enlarge during the first month of life, then gradually get smaller, usually disappearing by age 5 to 8 months.
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