Congenital Muscular Torticollis

Congenital muscular torticollis is a condition in which an infant's neck muscle is shortened causing the neck to twist. Most frequently the injury occurs to the muscle that goes diagonally across the neck from the collarbone (clavicle) to the head just behind the ear. Left untreated, congenital muscular torticollis may lead to significant craniofacial asymmetry and scoliosis. Heat, massage and passive stretching exercises are the preferred initial treatments for pseudotumor and torticollis. In almost 75% of the cases, the head is tilted toward the right. Congenital means present at birth and torticollis means twisted neck. The mass usually increases in size until one month of age, remains static for two to three months, then gradually diminishes in size and disappears clinically. Although the term "congenital" is used here, the condition is more correctly referred to as "infantile" or "childhood" torticollis, since it is not present at birth. Just a gentle push can begin the process of restoring the proper motion to the joints and relieve the muscular spasm. Facial asymmetry may be noted as early as two to three months of age and usually appears with flattening of the contralateral occipitoparietal region and the ipsilateral fronto-orbital region . When Wry Neck is present, the muscle is tighter than it should be and the head tilts and rotates.

Pseudotumor of infancy presents as a discrete, firm mass in the distal sternocleidomastoid muscle in infants two to four weeks of age. Congenital means present at birth and torticollis means twisted neck. Infants with CMT often suffer from recurring ear infections, upper respiratory infections and bouts of regurgitation. Diagnostic choices include fine-needle aspiration biopsy, cervical radiography, ultrasonography, computed tomographic scanning of the head and neck, and magnetic resonance imaging. CMT causes the back of the head to turn toward and the face to turn away from the affected side Chiropractic adjustments address the cause of the problem which is misalignment and malfunction of the first and second vertebrae in the neck. The condition usually occurs in children at birth and lasts until about three months of age but may persist and cause facial deformities.

Causes of Congenital Muscular Torticollis

The common causes of Congenital Muscular Torticollis :

• Injury to the neck during the delivery process
• The injured muscle develops fibrosis (scar tissue) which causes the muscle to shorten and tighten, pulling the infant's head to one side.
• Abnormalities of blood vessels and blood flow in the fetus
• The blood clots within the muscle and eventually scars. 
• The cause of congenital muscular torticollis is unknown, but heredity may play a more important role than has previously been suspected.
• These abnormalities result in the formation of a small scar inside the muscles of the neck. 

Symptoms of Congenital Muscular Torticollis

Important clinical symptoms include the history of the infection, the length of such history, the presence or absence of systemic symptoms or a history of any chronic auto-immune or lipid storage condition. Tuberculosis contact, the presence of cats in the house as well as any viral or bacterial infections, Mycobacteria other than tuberculosis or any medical history worthy of note are suggestive of these aetiologies. Some are:

• The infant's chin turns toward the opposite side
• firm, small, one to two centimeter mass in the middle of the sternocleidomastoid muscle
• Parents usually notice that a baby will not look in one particular.
• The chin is turned away from the affected side.
• Tilting of the head to one side, chin pointing toward opposite shoulder
• Possible observance of a lump or swelling in the muscle
• Limited range of motion in neck muscles

Treatment of Congenital Muscular Torticollis

• your child's tolerance for specific medications, procedures, or therapies
• gentle stretching exercise program (to help relieve the tension and lengthen the sternocleidomastoid muscle)
• surgery (to correct the shortened muscle)
• Place one hand on the shoulder of the affected side of the neck (the side with the tight cord-like feeling in the muscle) and the other hand on the top of the child's head.
• The surgery is to release the neck muscle, restore neck motion and this should correct the facial asymmetry.
• If done consistently, these interventions will work in nearly all affected babies.
• Some range-of-motion and stretching exercises are sometimes also used.

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