Congenital torticollis, what it is, symptoms, causes and treatments.

What is congenital torticollis?

Congenital torticollis is one of the most common neck disorders suffered by newborns. It is characterized by the baby adopting an altered position of the head, being rotated to the opposite side of the affected muscle and tilted to the same side. This position is caused by a sustained muscle contraction. The muscle causing this affectation is the STERNOCLEIDOMASTOID (ECOM), which may or may not present a nodule in its muscle belly, causing its shortening and malfunction. As a consequence of the maintained position, other muscles may also be shortened and tense, such as the angular of the scapula, the scalenes and the trapezius.

The exact cause of the pathology is not known.

The possible causes are:

• The position of the fetus in the womb.
• A complicated delivery. In which the muscle suffers a tear, with a possible hematoma that then causes a hardening of the tissue.

 

Diagnosis

It is usually diagnosed after birth. Early diagnosis is very important, both to begin treatment in consultation and postural hygiene as soon as possible, and to rule out other possible pathologies (plagiocephaly, neurological alteration, tumors) and to avoid future facial and cranial alterations.

When there is a mass (nodule) in the muscle belly it can be seen from birth and can be located manually and/or ultrasonographically. This nodule is usually located in the lower third of the muscle and can measure 1 or 2 cm in diameter, although sometimes it can grow during the first month of life.

The malpositioning of the newborn’s head is usually evident between the 2nd and 4th week of life. This symptom is the one that usually triggers the parents of the newborn to come to us or to the pediatrician, if it has not been diagnosed before.

The diagnosis of congenital torticollis is made by physical examination and palpation of the muscle belly. It is advisable in some cases to perform ultrasound or radiography to rule out other pathologies.

In physiotherapy consultation we assess:

• The tension presented by the muscle.
• The presence or not of nodule.
• The degree of cervical mobility the baby has, both passive and active.
• The presence or absence of facial and skull asymmetry.
• The general appearance of the child, in case we observe any anomaly.
• The degree of mobility and motor development according to their age.

Possible symptoms that the baby may present:

• Head position maintained (ear of the affected side towards the shoulder of the same side and the chin towards the opposite shoulder).
• Tension in the muscle and possible nodule (lump) in the muscle belly.
• Limitation of mobility, difficulty in turning the head to the opposite side of the infant’s posture.
• Face or head flattened by the maintained position (on the side of the affected muscle).

 

Treatments

Physiotherapy treatment

Physiotherapeutic treatment should be started as soon as possible, to prevent congenital torticollis from causing possible future impairment.

The objectives of the treatment are to relax the affected musculature, to stretch, to gain neck mobility and to reeducate posture.

The techniques used in consultation can be superficial thermotherapy, massage therapy and manual therapy on the affected musculature to relax and stretch it, passive and active-assisted mobilizations to gain lost mobility and sometimes we perform neuromuscular bandaging.

Most of the therapy is done through games, stimuli (visual and auditory), postures and with the help of the parents. There will be a part of the therapy that is passive in which the physiotherapist works analytically on the affected tissue and another part of the therapy that is more active on the part of the baby. In it we work stimulating the realization of flips, trunk flexion, straightening reactions and postural corrections.

Always in the treatment of the baby one of the parents comes into consultation with us to see how we perform the treatment. In addition, you will be able to calm the baby if necessary and learn the exercises and home guidelines that the physiotherapist will teach you.

It is very important for parents to be aware of the need to perform at home the exercises taught and the advice given by the professional.

Postural Treatment

As I mentioned earlier, the role of the family in this pathology is essential, they are the ones who will treat the baby on a daily basis and thus get the baby to gradually gain mobility in the sense of postural correction.

The exercises taught will depend on the age of the baby, but all have the same objective: to stretch, mainly, the sternocleidomastoid and have the baby turn the head to the side of the affected muscle.

They can be stimulated from all positions: lying face up, face down, sitting, in arms and in any action of everyday life: in the bathtub, feeding, playing, taking a walk in the stroller, put in the backpack or baby carrier, etc.. Any time is a good time to be “treating” the baby.

Both during treatment with the physiotherapist and parents at home should:

• Always give stimuli in the sense of correction, whether visual, auditory, with toys.
• Avoid postures that may worsen your condition by changing your posture regularly.
• Breast or bottle feeding on the correction side.
• Hold him in the arms looking for the stretching of the muscle, turning his head to the opposite side of the deformity.
• Place a pillow on the affected side to avoid pinning the ear to the shoulder, if on the back.
• When lying face down, place the head in the opposite position to its usual position (looking for correction and stretching of the muscle).
• Position the crib or bed so that the door (where it receives the sounds of the parents entering the room), the crib mobile, the nightlight are on the side of the affected muscle so that the baby turns to that side.
• Place them face down for the child to perform head and trunk extension.

It often happens that parents find it difficult to know WHERE they have to make the child look and from where they have to stimulate him/her. Here is an example to make it easier to understand how to act.

If the baby’s right side muscle is affected (shortened), his head will be rotated to the left (he will always look to his left) and his right ear will be “glued” to his right shoulder. Bearing in mind that we have to stimulate towards correction, we should play, call him, teach him the rattle… on his right side, in order to stretch the muscle.

The specific exercises taught by the physiotherapist should be done 4 to 5 times a day, for 10-15 minutes.

Surgical Treatment

This type of treatment is resorted to when the pathology does not disappear with conservative treatment.

Children diagnosed at more than one year of age or children between 6-12 months who continue to have head rotation limitation or clinically significant plagiocephaly and/or facial asymmetry are susceptible to referral to traumatology.

Traditionally, the method used in the surgery of this pathology has been the section of the muscle, disinsertion of one of the ends of the muscle or its lengthening.

In recent years, a technique in which no cuts are made in the muscle has gained relevance, in order to avoid scarring that may cause movement restrictions and the risk of suffering the same pathology as a consequence of post-scarring fibrosis. The technique consists of grafting fat with regenerative cells in the areas of fibrosis. As there are no wounds, recovery is faster.

 

In many cases there is no real affectation of the muscle, the baby simply adopts this “vice” for convenience and it is only necessary to re-educate his posture. If you notice that your baby always looks to the same side, always has the same posture in the crib or stroller, it is difficult for him to turn to one side or you notice that one side of his face is more flattened, do not hesitate to come to our MIVI centers. We will be happy to treat your baby and advise you on how to treat him at home.