Clinical Reference Systems: Pediatric Advisor 10.0

Description

Congenital muscular torticollis (CMT) is an injury to a neck muscle that happens at birth. Congenital means that the condition is present at birth. Torticollis means twisted neck. 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. This is muscle called the sternocleidomastoid muscle.

CMT causes the back of the head to turn toward and the face to turn away from the affected side. Your child will not want to move his or her face towards the affected side because of pain.

Cause

Injury to the muscle usually occurs during birth. The injury is caused by stretching of the muscle during the delivery of the head. When the stretching is severe, there is tearing and bleeding into the muscle. If enough bleeding and swelling occurs, pressure builds up and damages the muscle. Then, scar tissue replaces some of the muscle. As a result the baby keeps the neck turned in one direction.

There can be other causes of twisting of the neck of a newborn but none of these cause the swelling in the sternocleidomastoid muscle that occurs in CMT.

Diagnosis

CMT is a diagnosis that should be made after an exam by a physician.

Treatment

Many times children with CMT get better on their own. You can help your child improve by putting your child in situations where she has to stretch the affected muscle on her own. For example, lay the child in the crib so that if she wants to see what is going on in the room, she will have to turn her chin towards the shoulder of the affected side. This will stretch the affected muscle and help cure the torticollis naturally.

Treatment of CMT involves passive stretching exercises. This means that you help your baby move her neck. Exercises to improve CMT are described below. Do these exercises in sets of 10 repetitions, three times each day.

1. Side bend: 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. Gently move the neck so that the child is looking straight ahead. With the child looking straight forward, gently bend the neck so the ear opposite the affected side goes toward or touches the shoulder on that side. Gentle downward pressure can also be applied to the shoulder on the affected side.

2. Head turn: With the hand on the shoulder of the affected side and the other hand on the top of the child's head, gently move the neck so that the child is looking straight ahead. Now gently turn the child's head so that the chin moves toward the shoulder of the injured side. (The opposite direction of the way the child prefers to turn the head.) Gentle downward pressure can also be applied to the shoulder on the affected side.

Your baby may be referred to a physical therapist to help determine how the treatment is going. If the condition is still present after the age of 1 year, your child may need surgery to restore movement of the muscle.

Call Your Child's Physician If:

• You need to know how often your doctor wants to see your child.
• The torticollis gets noticeably worse.
• You have other questions or concerns.