Congenital Muscular Torticollis

Congenital Muscular Torticollis (Wryneck)

Congenital muscular torticollis, also called wryneck, is usually discovered in the first 6 to 8 weeks of life. The infant keeps his or her head tilted to one side and has difficulty turning the head to the opposite side.

If the infant is examined in the first month, a mass, or "tumor," may be felt in the neck. This is nontender and soft. It is attached to the muscle in the neck on the side to which the head is tilting. The mass gradually regresses so that by 4 to 6 months of age the "tumor" is gone.


A young child with a right-sided congenital muscular torticollis. Notice how the face turns away from the tight muscle. (Courtesy of Texas Scottish Rite Hospital for Children)

Congenital muscular torticollis can be associated with hip dysplasia (10% to 20%) so the hips should be examined in children with torticollis.

If you notice that your child holds the head tilted to one side, consult your physician. Other conditions can cause torticollis, and the physician will check for those during the physical examination. X-rays and/or an ultrasound of the neck and/or hips may be taken.

Ninety percent of children can be treated successfully with a stretching exercise program.

Cause

First-born children are more likely to have torticollis (and hip dislocation). This is likely from intrauterine "packing," resulting in injury to the muscle. The "tumor" is seen with response to the injury. As this resolves, the amount of scar in the muscle determines how tight the muscle is. There is no known prevention.

Symptoms

The head tilts to one side and the chin points to the opposite shoulder. The right side is involved 75% of the time. The lump is found in the muscle and it gradually goes away. There is limited range of motion of the neck. One side of the face and head may flatten as the child always sleeps on one side.

Treatment

The usual treatment consists of stretching exercises to turn the head so that the chin touches each shoulder and also so that the ear touches the shoulder.

There are other options that can help. Position toys where the infant has to turn his head to see them. Carry the child so that they have to look to the involved side. Place the child in bed with the involved side toward the wall so that they have to look the opposite way to see you outside the crib.

In 10% of children, surgery may be needed to correct the torticollis. This is an outpatient surgery to lengthen the short muscle.