Introduction:
Torticollis is a developmental condition that affects newborns. It gets resolved on its own by various physiotherapy methods and regular monitoring by a pediatrician. In torticollis, the muscle behind the ear region becomes stiff, making it difficult to rotate the neck. Rarely do children born with this deformity develop conditions like plagiocephaly, where the skull bone gets flattened at the backside. Other associated conditions can develop as a result of torticollis.
What Is a Congenital Muscular Torticollis?
Congenital Muscular Torticollis: It is a condition affecting the newborn. It is caused due to the tightening of neck muscles during delivery or congenital disabilities occurring during pregnancy. Torticollis affects the sternocleidomastoid muscles present in the neck region. The muscles become shortened, and as a result, it causes stiffness in the neck. It can also occur due to unknown causes. When much pressure is exerted on the muscle during delivery, it can lead to torticollis. Other factors triggering this condition are womb positioning, difficult childbirth, and post-birth positioning. Clinically, the child shows a deviation of the head on the contracted muscle side, which pulls the chin to the opposite side. The child faces difficulty in freely moving the head. The condition resolves on its own over a period of time of several months. However, the tightening of neck muscles gives rise to other complications, such as:
Developmental Dysplasia of the Hip (DDH): Hip dysplasia is caused due to deformity in the hip joint formation. The hip ball and socket do not fit properly and cause difficulty in walking alignment. It is also observed that the length of the legs is not in the same proportion, which can eventually lead to dislocation of the knee cap, and the patient finds it difficult to stand balanced on both legs and puts pressure on one single leg while standing. Certain risk factors can trigger hip dysplasia, such as a high chance of developing this condition among female children and firstborn infants who have a foot delivery first. Various braces and other surgical procedures are present to correct the knee ligaments against frequent dislocations.
Klippel - Feil Syndrome (KFS): This is a rather serious condition affecting the vertebral column where two disks fuse together. The cause of this condition is unknown and sometimes related to genetic mutations. KFS can lead to a short neck, restricted movement of the upper spine, and nerve pain, causing headache and neck pain. Patients with KFS should be careful while doing physical exertions as they are more prone to spine injuries.
Metatarsus Adductus: It is seen in twenty percent of cases who suffer from torticollis. Children born with this condition have an inward twisting of the foot. This can be corrected while giving oil massage to babies during baths. There are instances where the legs are not flexible enough to reposition them back. This can again lead to hip joint dislocation due to improper positioning of the sockets, as it is too shallow to hold the joint in position. It could also develop due to familial or genetically inherent traits. Children born with metatarsus find it difficult to join the heel and foot together in one plane. Most of the associated conditions caused by torticollis are seen in the case of breach delivery or normal vaginal birth.
What Are the Associated Symptoms of Torticollis?
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Children with torticollis show other physical deformities besides tightening neck muscles. Some of the symptoms known are:
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A firm palpable mass is noted in the neck within the first four weeks of life.
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Tilting of the head towards one position is noted.
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A deep crease on the neck and shoulder is observed.
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Pain in the neck.
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Inflammation of the neck causes muscle spasms.
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In severe cases, patients may experience double vision, headache, and photosensitivity.
How Is Breastfeeding Done in Babies With Torticollis?
Babies born with torticollis have greater difficulty while breastfeeding or bottle feeding. The child has shoulder deviation limited to one side of the neck, which leads to the sucking of either one of the breasts. The mother should adopt a position opposite the child’s, favoring deviated neck position. The child should also be encouraged to change their neck position while playing with toys as this stimulates the stretching of the neck muscles. The child must be put in a tummy position while bottle feeding as this stretches the neck muscle, and they should be involved in games and activities that promote neck rotation from all sides. Make sure to switch positions while breastfeeding, as this improves neck movement.
How Can Torticollis Be Detected Early?
The following diagnostic methods can be used to detect torticollis at an early stage:
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Physical Examination: Torticollis can be physically examined post-childbirth with the presenting clinical features like difficulty in rotation and side-bending movements of the neck.
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Ultrasonography (USG): There are conditions like congenital torticollis, which are present at birth and can be diagnosed early using various tests like ultrasonography.
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Computed Tomography (CT): This is done to visualize the growth defect of a child in the uterus.
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Magnetic Resonance Imaging (MRI): This procedure is carried out with the help of a high magnetic field to capture more precise imaging of the developing fetus in the uterus.
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Electromyography (EMG): This is used to study the state of muscles.
Torticollis can be acquired during childbirth as a result of prolonged delivery pain, breach of birth, and improper positioning of the baby in the mother’s womb. In acquired torticollis, the child gets injured in the neck muscles during the delivery time and injures the sternocleidomastoid muscles causing stiffening of the neck. There are other causes that can lead to acquired torticollis, such as tumors, infections, diseases of cervical vertebrae, prolonged unusual positions, throat infections, ear infections, and the use of certain drugs like antipsychotics.
Can Congenital Muscular Torticollis Be Treated?
Yes, almost all cases of torticollis resolve independently. Many physical exercises, along with passive stretching techniques, help resolve muscle stiffness. During exercise, the head is tilted laterally away from the affected side, and the chin is rotated towards the affected side. Apart from physiotherapy sessions, other modes of treatment using surgical procedures can also be used to correct the deformity.
One such surgical procedure is the Z plasty technique in severe cases. Children with stiff necks are advised for such surgeries when it does not get corrected even after one year. The movement of eye muscles is also noted in such scenarios. The child can be managed by shifting to alternate positions while lifting the baby in arms and can be prevented from lying in the same position for too long, and sleep positions can be changed accordingly. Children are managed at birth by giving botulinum injections and muscle release techniques following a surgical procedure to enhance the free movement of neck muscles. Both conservative and surgical methods have gained positive results in treating torticollis.
Conclusion:
About ninety percent of cases born with torticollis resolve independently within the first few months of delivery. The child develops passive stretching of muscles which helps correct the deformity. The management of torticollis depends on the cause and can be treated accordingly. It can be managed by physiotherapy sessions if it is a mild muscle deformity. In severe cases, surgical management is done by administering drugs like muscle relaxants, painkillers, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), and antidepressants. All these procedures are carried out under the guidance of a physician.
