II. Etiologies

  1. Sternocleidomastoid Muscle injury from Birth Trauma
    1. Hematoma and fibrosis results in Muscle shortening
  2. Muscle adaptation from abnormal intrauterine position
  3. Cervical Vertebral abnormalities
    1. Suggested by limited neck range of motion at birth

III. Pathophysiology

  1. Unilateral shortening of sternocleidomastoid Muscle

IV. Associated Conditions

  1. Congenital asymmetric contractures of hip abductors
  2. Unilateral Congenital Hip Dysplasia
  3. Unilateral Metatarsus Adductus

V. Signs

  1. Head Tilt toward the affected side
  2. Limited neck range of motion
    1. May suggest cervical Vertebral abnormality
  3. Face and skull asymmetry from lack of position change
  4. Palpable mass within sternocleidomastoid Muscle
    1. Gradually disappears and is replaced by fibrous knot

VI. Images

VII. Radiology

  1. Neck XRay
    1. Indicated for significantly limited neck ROM
  2. Ultrasound Hips
    1. Assess for concurrent Congenital Hip Dysplasia
    2. Indicated for significant hip abductor tightness

VIII. Management

  1. Positioning head opposite affected side
    1. Padded bricks
    2. Sandbags
  2. Passive Stretching
    1. Rotate infants head to affected side
    2. Tilt head backwards (extend) away from affected side
  3. Surgical release of sternocleiodomastoid Muscle
    1. Indicated for limited range of motion at 1 year

IX. Course

  1. Minimal signs at birth
  2. Torticollis evident by 2 to 3 weeks
  3. Recovery over 3 to 4 months with therapy
  4. Complete resolution by 1 year with therapy

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