Abnormal or constricting intrauterine position of a fetus may result in congenital torticollis, noticeable at birth. Idiopathic, spasmodic torticollis results from spasm and shortening of the sternocleidomastoid muscle (SCM) and rotation of the head. Additional causes may include upper respiratory infections, infections of the cervical spine, compression of brain or brainstem due to aberrant blood vessels or tumors, hemorrhage into the cervical musculature compensation for unbalanced, abnormal eye movement and “double vision”.
In nearly all cases the SCM becomes foreshortened due to local irritation of the muscle or its controlling nerve. If left untreated torticollis may persist or worsen and cause secondary problems with head and neck positioning, jaw development, eye movement or visual processing, abnormal skull shape or respiratory function. If an underlying cause is identified and treated the torticollis will usually resolve. Physical therapy can be extremely useful in the treatment of torticollis as well as relaxation training, psychiatric evaluation and trans-epidermal neuro-stimulation. Botulinum toxin may work in select cases and more aggressive surgical measures (brainstem / cranial nerve decompression) are rarely needed.
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