Congenital torticollis: Difference between revisions

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<br>The sternocleidomastoid muscle has a sternal and clavicular head. The sternal head is directed from the manubrium sterni superiorly, laterally and posteriorly and the clavicular from the medial third of the clavicle vertically upward. It runs to the mastoid process. It enables an ipsilateral lateral flexion and a contralateral rotation. The muscle extends the upper part of the cervical spine and flexes the lower part<ref name="6">Butterworth, Heinemann. Functional anatomy of the spine: second edition. 2005, Elsevier Ltd. (Level of Evidence 5)</ref>.<br>
<br>The sternocleidomastoid muscle has a sternal and clavicular head. The sternal head is directed from the manubrium sterni superiorly, laterally and posteriorly and the clavicular from the medial third of the clavicle vertically upward. It runs to the mastoid process. It enables an ipsilateral lateral flexion and a contralateral rotation. The muscle extends the upper part of the cervical spine and flexes the lower part<ref name="6">Butterworth, Heinemann. Functional anatomy of the spine: second edition. 2005, Elsevier Ltd. (Level of Evidence 5)</ref>.<br>


== Epidemiology /Etiology ==
== Epidemiology /Etiology == Congenital torticollis occurs in 0.4 to 3.94% of births according to different sources<ref name="3"></ref><ref name="5"></ref><ref name="7"></ref>. It is the third most common musculoskeletal abnormality in infants<ref name="3"></ref><ref name="4"></ref><ref name="5"></ref><span style="line-height: 1.5em;">).</span> <br>The true etiology remains controversial<ref name="4"></ref>. So far more than 80 entities have been described that can cause torticollis<ref name="7"></ref>. We can differentiate several frequent causes of congenital torticollis: <br> *Muscular in more than 80% of the cases<ref name="1"></ref>. Types muscular torticollis<br>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - Fibromatosis colli: torticollis with palpable mass in the SCM;<br>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - Tightness of the SCM without an apparent mass; *Postural torticollis with neither mass or tightness<ref name="1"></ref>. *Birth trauma: facet dislocation, tears in the sternocleidomastoid muscle *Congenital anomalies of the craniovertebral junction: occipitoatlantal fusion or [http://www.physio-pedia.com/Klippel-Feil_syndrome Klippel-Feil syndrome]<ref name="1"></ref><ref name="5"></ref>. *Sternocleidomastoid tumour <ref name="1"></ref> *Ocular abnormalities<ref name="1"></ref> *Intrauterine mechanical factors<ref name="1"></ref><ref name="5"></ref><br> A common hypothesis of muscular torticollis is that intrauterine constraint limits head mobility and leads to progressive degrees of neck contracture. The severity depends on the duration of prenatal immobility<ref name="5"></ref>. There is no difference in clinical severity based on the method of child birth<ref name="5"></ref>.<br>
 
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== Characteristics/Clinical Presentation  ==
== Characteristics/Clinical Presentation  ==

Revision as of 08:15, 19 June 2013

 

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Definition/Description

Congenital torticollis or wry neck is a condition in infants detected at birth or shortly afterCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. It is characterized by rotational deformity of the cervical spine with secondary tilting of the head Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. There is a lateral head tilt to one side and contralateral rotationCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title[1]. It is most commonly the result of unilateral shortening and thickening or excessive contraction of the sternocleidomastoid muscle Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The basic abnormality is known as endomysial fibrosis with deposition of collagen and migration of fibroblasts around individual muscle fibersCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. It leads to a limitation of the head mobility in both rotation and lateral flexion and progressive degrees of neck contractureCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.

Clinically Relevant Anatomy[edit | edit source]

The normal physiologic range of rotation of the atlas on the axis is 25o-53o degrees to either side. The transverse ligament is the primary stabilizer of the atlantoaxial joint and prevents excessive anterior motion of the atlas on the axis. It extends behind the dens, between the medial portions of the lateral masses of C1Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The paired alar ligaments act as secondary stabilizers to prevent anterior shift. The alar ligaments extend from the lateral aspect of the dens tip to the medial aspect of the occipital condyles, with a lower portion attaching to the medial aspect of the lateral masses of C1Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.


The sternocleidomastoid muscle has a sternal and clavicular head. The sternal head is directed from the manubrium sterni superiorly, laterally and posteriorly and the clavicular from the medial third of the clavicle vertically upward. It runs to the mastoid process. It enables an ipsilateral lateral flexion and a contralateral rotation. The muscle extends the upper part of the cervical spine and flexes the lower partCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.

== Epidemiology /Etiology == Congenital torticollis occurs in 0.4 to 3.94% of births according to different sourcesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. It is the third most common musculoskeletal abnormality in infantsCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title).
The true etiology remains controversialCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. So far more than 80 entities have been described that can cause torticollisCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. We can differentiate several frequent causes of congenital torticollis:
*Muscular in more than 80% of the casesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. Types muscular torticollis
              - Fibromatosis colli: torticollis with palpable mass in the SCM;
              - Tightness of the SCM without an apparent mass; *Postural torticollis with neither mass or tightnessCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. *Birth trauma: facet dislocation, tears in the sternocleidomastoid muscle *Congenital anomalies of the craniovertebral junction: occipitoatlantal fusion or Klippel-Feil syndromeCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. *Sternocleidomastoid tumour Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title *Ocular abnormalitiesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title *Intrauterine mechanical factorsCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
A common hypothesis of muscular torticollis is that intrauterine constraint limits head mobility and leads to progressive degrees of neck contracture. The severity depends on the duration of prenatal immobilityCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. There is no difference in clinical severity based on the method of child birthCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.

Characteristics/Clinical Presentation[edit | edit source]

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References[edit | edit source]

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  1. Petronic I., et al. Congenital muscular torticollis in children: distribution, treatment duration and outcome. European Journal of Physical and Rehabilitation Medicine. 2010; 45(2): 153-158 (Level of Evidence 2)