Torticollis is an abnormal posture of the head and neck that results from multiple causes.
Positional torticollis is a condition when the neck becomes tight and shortened. That muscle is called the sternocleidomastoid muscle. Sometimes an infant will be born with torticollis because of its position inside the uterus or during birth. Other times, an infant will develop torticollis because they favor looking to one side. The baby will tend to turn their head to one side, may even have difficulty turning it to the other direction, and a head tilt will be seen. If left untreated, torticollis can cause another condition called positional plagiocephaly which is often referred to as flat head.
Physical therapy can be very helpful in treating torticollis. Preventative measures include alternating sides during feedings, changing the direction the baby sleeps in their crib, and putting fun and interesting objects on the side they avoid so their attention is drawn in that direction. Tummy Time is very important for babies. At least two hours each day, broken down into smaller sessions, is recommended.
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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