Torticollis is also known commonly as "wry neck." It is a deformity of the neck in which the head tilts toward one shoulder and is simultanously the chin rotates toward the opposite shoulder.

Congenital muscular torticollis is by far the most common form. It is associated with a mass in the sternocleidomastoid muscle (the strap that courses from beneath the angle of the jaw to the base of the neck above the medial end of the collarbone. The right sided muscle is involved 75% of the time.

It is usually diagnosed in the first couple of months of life. If it is picked up in the first few weeks, there may be a soft lump the size of an olive felt in the belly of the muscle. This generally disappears, and the muscle feels just tight and shortened. Torticollis in babies older than a month who don't have a tight sternocleidomastoid could be a sign of another condition; this is worrisome.

The theory is that during vaginal delivery, blood flow to the affect neck muscle is reduced, causing damage. This theory sounds pretty good for most cases, but there are familial cases and cases where the baby was born by C-section. Go figure.

About 8% of babies born with congenital muscular torticollis have developmental dysplasia of the hip, so careful evaluation (to include a hip ultrasound) is imperative. Neck xrays are probably advisable for babies with torticollis as well, to rule out abnormalities of the neck vertebrae which can masquerade as simple muscular torticollis.

Torticollis may cause permanent facial deformity if it is not resolved in the first year. Physical therapy is the treatment of choice, and is almost always curative. Your doctor will either show you how to do the therapy or refer you to a physical therapist. It should be essentially gone within three months of therapy, or an orhtopedist should do a more detailed evaluation for other possible causes of the torticollis, which could be significant. If physical therapy doesn't do the trick for congenital muscular torticollis, the sternocleidomastoid muscle will need to be surgically lengthened.

Torticollis can be acquired beyond the newborn period. A stiff neck or a crick in the neck is a common office problem in pediatrics. The child has a sudden onset of intense pain and stiffness in the muscles of the neck on one side. It is almost always just a stiff neck. A cervical collar, rest, and perhaps some muscle relaxant medication will cure the condition and put everyone's mind at ease.

While this could be a more serious condition of atlanto-axial subluxation (a rare condition: twisting of the first and second neck vertebrae out of position), it almost never is.
Just remember that the ordinary stiff neck in older kids should be better within two or three days, and call your doctor if it isn't.

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