Torticollis (Wryneck)

It is the permanent tilting of the head toward one shoulder due to the contraction, shortening, or spasm of the thick cervical muscle (SCM muscle) located on both sides of the neck, which allows us to rotate our head.

The most common type observed in infants is Congenital Torticollis. It arises due to intrauterine malpositioning or hemorrhage within the cervical muscle during a difficult (vacuum-assisted) delivery, leading to fibrotic scar tissue formation and subsequent muscle shortening during the healing process.

Acquired types developing later in adults generally occur due to sleeping in a poor position/on an improper pillow resulting in localized cold exposure and severe muscle spasm (acute wryneck), sudden neck movements (trauma), or an underlying neurological central stimulus (Cervical Dystonia).

Because an infant with untreated torticollis is compelled to lie constantly on the same side, unilateral cranial flattening (plagiocephaly) develops. In subsequent years, the asymmetric posture leads to facial skeletal deformities and the development of spinal scoliosis.

The clinical posture is so distinctive that it is diagnosed immediately upon visual inspection of the infant or patient by the physician. A firm, olive-sized mass (fibromatosis colli) may be palpable within the infant's cervical muscle. If indicated, a Cervical Ultrasonography is performed to evaluate the muscle architecture.

In infants, a 90% complete resolution rate is achieved through simple lateral Stretching and Range-of-Motion exercises (Physiotherapy) implemented within the first 6 months of life. In refractory, fibrotic shortenings unresponsive to exercises, orthopedic surgeons perform a surgical muscle release and lengthening after 1 year of age. For persistent spasms in adults, Botulinum Toxin (Botox) injections are administered into the muscle to induce relaxation.