MSK - Torticollis

Question 1

Definition

Answer 1

A neck deformity that involves shortening of the sternocleidomastoid (SCM) muscle resulting in limited neck rotation and lateral flexion

Question 2

Epidemiology

Answer 2

A male to female predominance of 3:2 has been reported

Question 3

Aetiology

Answer 3

Unknown

Question 4

Pathophysiology

Answer 4

A neck deformity that involves shortening of the sternocleidomastoid (SCM) muscle resulting in limited neck rotation and lateral flexion

Question 5

Classic sign

Answer 5

Children tilt their head towards the side of the shortened muscle and rotate to the contra lateral side

Question 6

Symptoms

Answer 6

• Head towards the side of the shortened muscle
• Rotate to the contra lateral side
• Ipsilateral shoulder elevation

Question 7

Diagnosis

Answer 7

FIRST LINE: Cervical spine x-ray
- negative CMT
- should be obtained routinely at initial visit to rule out vertebral anomalies
Pelvic X-ray and hip USS
Neck USS

Question 8

Treatment

Answer 8

FIRST LINE: Physiotherapy and home programme
Consider cranial moulding orthosis
SECOND LINE: Botulinum toxin type A = Injection into the SCM or upper trapezius muscle = performed in children with CMT that is refractory to physiotherapy and a home programme
THIRD LINE = SCM muscle release = persistent CMT despite FL + SL

Question 9

Complications

Answer 9

Intermittent head tilt
Persistent craniofacial asymmetry

Question 10

Risk factors

Answer 10

Breech delivery
C-section
Birth trauma
Complicated delivery
Plagiocephaly