Congenital Torticollis CAT

Question 1

What is torticollis?

Answer 1

A condition that causes the neck to involuntarily unilaterally contract to one side secondary to contraction of the SCM

Question 2

What does torticollis look like?

Answer 2

• Ipsilateral lateral flexion
• Contralateral rotation to the affected side

Question 3

When does torticollis appear in kids?

Answer 3

• Infant will appear normal at birth
• Swelling will appear over the injured SCM over the course of days and weeks

Question 4

Etiology of torticollis

Answer 4

• May be local trauma to soft tissues of neck during birth
• May be malpositioning in utero

Question 5

Clinical presentation for torticollis

Answer 5

• Lateral flexion to, cervical rotation away from affected side
• Intermittent painful spasms of SCM, traps, and other neck muscles
• Nontender enlargement of SCM

Question 6

How long does the mass last?

Answer 6

~ 6 months, after which the contracture is the only presentation

Question 7

How long should conservative management last before considering surgical intervention?

Answer 7

12-24 months

Question 8

Pharmacological management of torticollis

Answer 8

• NSAIDs, benzodiazepines (muscle relaxants), anticholinergics, local intramuscular injections (botox or phenol)

Question 9

PT management of torticollis

Answer 9

• Family/caregiver ed
• Passive stretching of muscles
• Massage
• Local heat
• Biofeedback
• TENS
• AROM + strengthening
• Positioning