http://www.fpnotebook.com/

Torticollis

Etiologies
1. Sternocleidomastoid muscle injury from Birth Trauma
  1. Hematoma and fibrosis results in muscle shortening
2. Muscle adaptation from abnormal intrauterine position
3. Cervical vertebral abnormalities
  1. Suggested by limited neck ROM at birth
Pathophysiology
1. Unilateral shortening of sternocleidomastoid muscle
Associated Conditions
1. Congenital asymmetric contractures of hip abductors
2. Unilateral Congenital Hip dysplasia
3. Unilateral Metatarsus Adductus
Signs
1. Head Tilt toward the affected side
2. Limited neck range of motion
  1. May suggest cervical vertebral abnormality
3. Face and skull asymmetry from lack of position change
4. Palpable mass within sternocleidomastoid muscle
  1. Gradually disappears and is replaced by fibrous knot
Images
Radiology
1. Neck XRay
  1. Indicated for significantly limited neck ROM
2. Ultrasound Hips
  1. Assess for concurrent Congenital Hip dysplasia
  2. Indicated for significant hip abductor tightness
Management
1. Positioning head opposite affected side
  1. Padded bricks
  2. Sandbags
2. Passive Stretching
  1. Rotate infants head to affected side
  2. Tilt head backwards (extend) away from affected side
3. Surgical release of sternocleiodomastoid muscle
  1. Indicated for limited range of motion at 1 year
Course
1. Minimal signs at birth
2. Torticollis evident by 2 to 3 weeks
3. Recovery over 3 to 4 months with therapy
4. Complete resolution by 1 year with therapy

Torticollis (C0040485)
Definition (MSH)	A symptom, not a disease, of a twisted neck. In most instances, the head is tipped toward one side and the chin rotated toward the other. The involuntary muscle contractions in the neck region of patients with torticollis can be due to congenital defects, trauma, inflammation, tumors, and neurological or other factors.
Definition (CSP)	contracted state of the cervical muscles, producing twisting of the neck and an unnatural position of the head.
Concepts	Sign or Symptom (T184)
ICD9	723.5, 723.5
MSH	D014103
English	Contracture of neck, Retrocollis, Torticollis, Torticollis - symptom, Torticollis unspecified, Wry neck, Wry neck symptom, Wry neck/torticollis, Wryneck
Spanish	contractura de cuello, contractura del cuello, cuello torcido/torticolis, torticolis
Parent Concepts	spinal symptom and disorder (C0679389), Myopathy (C0026848), Brain Diseases (C0006111), Movement Disorders (C0026650), Other disorders of cervical region (C0158279), Dystonia (C0013421), Dystonic Disorder (C0393593), Contracture (C0009917), Torticollis (C0040485), Duplicate concept (C1274013), Musculoskeletal disorder of the neck (C1290143), Disorder of cervical spine (C1290145), Ambiguous concept (C1274012)
Sources	AOD, COSTAR, CSP, CST, DXP, ICD9CM, LCH, MEDLINEPLUS, MSH, MTH, MTHICD9, NDFRT, OMIM, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System)