# Congenital muscular torticollis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Congenital Torticollis - StatPearls (NCBI Bookshelf NBK549778) - https://www.ncbi.nlm.nih.gov/books/NBK549778/ · Congenital muscular torticollis - disease-level clinical article (congenital-muscular-torticollis-full.txt) · Congenital muscular torticollis - disease-level clinical article (congenital-muscular-torticollis-clinical.txt) - Verified date: 2026-08 ## Verified against - Congenital Torticollis - StatPearls (NCBI Bookshelf NBK549778) - https://www.ncbi.nlm.nih.gov/books/NBK549778/ - Congenital muscular torticollis - disease-level clinical article (congenital-muscular-torticollis-full.txt) - Congenital muscular torticollis - disease-level clinical article (congenital-muscular-torticollis-clinical.txt) ## Treatment metadata - Stretching, positioning and a hip check - refer early (Recognition & Referral) ## Complete treatment card ```text CONGENITAL MUSCULAR TORTICOLLIS Sources: Congenital Torticollis - StatPearls (NCBI Bookshelf NBK549778) - https://www.ncbi.nlm.nih.gov/books/NBK549778/ · Congenital muscular torticollis - disease- level clinical article (congenital-muscular-torticollis-full.txt) · Congenital muscular torticollis - disease-level clinical article (congenital-muscular-torticollis-clinical.txt) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (2) - Parents often notice and raise concern about the infant's tilted head first - History should cover low amniotic fluid, a difficult delivery, or a breech position, since these raise the risk SIGNS - what you find (5) - The sternocleidomastoid muscle is fibrosed or shortened on the affected side - The head tilts toward the affected side and turns toward the other side, with limited active and passive neck motion and a fixed, stiff neck [neck stiffness] - A firm, movable, painless lump over the sternocleidomastoid appears at 2 to 3 weeks of age, growing to about almond size before often disappearing by 8 months [skin nodule] - Skull shape can change, with flattening at the back of the head and the opposite ear pushed forward - In older children the muscle becomes thickened and shortened, limiting rotation and side- bending of the neck toward the unaffected side TESTS (6) - Passive neck range of motion can be measured with a goniometer, usually by a physical therapist - Vision should be checked, including eye alignment, red reflex, and pupil reaction, since weak eye muscles can cause a compensatory head tilt - Hip dysplasia affects roughly 15 to 20% of these infants, so a hip exam and ultrasound at 4 to 6 weeks, or an X-ray at 4 to 6 months, is recommended - The Ortolani/Barlow signs and limited hip abduction are major clinical signs of hip dysplasia, while the Galeazzi sign and asymmetric skin folds are minor ones - Ultrasound is the most common imaging in the newborn period and helps assess a neck lump and monitor treatment - MRI can help rule out a nonmuscular cause of the head tilt IF NOT THIS - what else fits (2) - Vertebral anomalies such as hemivertebrae or Klippel-Feil syndrome should be considered - Congenital absence of the sternocleidomastoid muscle on one side is also a differential Source Congenital muscular torticollis - disease-level clinical article (congenital-muscular- torticollis-full.txt) Status traced to the source above 1. STRETCHING, POSITIONING AND A HIP CHECK - REFER EARLY (RECOGNITION & REFERRAL)[1st line] Adult Source Congenital Torticollis - StatPearls (NCBI Bookshelf NBK549778) - https://www.ncbi.nlm.nih.gov/books/NBK549778/ Why No medicine is used. The intervention is physiotherapy started early, and the two things primary care must not miss are the hip that comes with it and the head tilt that is not muscular at all. Caution WHAT IT IS - the sternocleidomastoid on 1 side is contracted or fibrosed, so the head inclines towards that side while the face and chin rotate to the other. In other words, the head tips towards the tight muscle and the chin turns away from it. TIMING SEPARATES IT FROM EVERYTHING ELSE - the congenital form is there at birth or appears in the first weeks, and it has to be told apart from the acquired forms. Acquired torticollis can start at any age, on the back of a congenital skeletal anomaly, injury, infection, inflammation in a neighbouring structure, a tumour, or an ocular or neurological dystonia. A neck that twists for the first time in an older child who was normal until then is not this diagnosis and needs urgent assessment. THE LUMP IN THE NECK IS PART OF IT - a painless mass felt in the side of the neck, within the sternocleidomastoid, showing up in a neonate at about 2 to 3 weeks. It may go on growing for 2 months, to roughly the size of an almond, and then start to regress; it can be gone altogether by the eighth month. Painless, within the muscle, in a young infant - a painful or enlarging neck mass is a different problem. CHECK THE HIPS. THIS IS THE MISS THAT COSTS A CHILD A JOINT - congenital hip dysplasia comes with congenital torticollis in up to 20% of cases. The article puts the incidence at roughly 15%, while noting other studies reporting hip dysplasia in 1 of every 5 babies with congenital torticollis. Its instruction: examine the hips regularly and scan them by ultrasound at 4 to 6 weeks of age. A plain radiograph of the hips does the same job at 4 to 6 months. EXAMINE THE EYES AND THE NEUROLOGY BEFORE ACCEPTING THE DIAGNOSIS - neurological and auditory assessment is fundamental, to rule the other differentials out. Where the examination finds no contracture in the muscle and the joint range is intact, that suspicion sends the child to ophthalmology. A tilt with a normal, supple neck is ocular until proven otherwise. Weakness of an oculomotor muscle - the lateral rectus, say, or the superior oblique - can mean the torticollis is a compensation, adopted to see better. THE SERIOUS DIFFERENTIALS THE ARTICLE NAMES - vertebral anomalies, hemivertebrae and Klippel-Feil syndrome among them; Arnold-Chiari malformation; syringomyelia; a tumour of the cervical spine; a brain tumour. Anything with abnormal neurology, pain, or an onset outside the newborn period goes to a paediatrician rather than to a physiotherapist. TREATMENT IS PHYSIOTHERAPY, AND EARLY IS THE WHOLE POINT - physical therapy is the cornerstone, congenital or acquired alike. Treated properly, 90% to 95% of children are improving before their first birthday, and 97% improve where treatment starts inside the first 6 months. A palpable mass is itself a trigger to begin - the article calls it an important indicator for starting by the second month of life. WHAT THE PARENTS ACTUALLY DO AT HOME - manual stretches in flexion, extension and lateral rotation, at least 3 times a week, 15 stretches to a set. Hold each one for 1 second. Between repetitions, pause 10 seconds. Then the positioning: build it into the daily routine, at feeds among other times, turning the chin towards the affected shoulder. And supervised time on the tummy while the baby is awake, which helps the motor skills develop in prone. THE FLAT HEAD IS A CONSEQUENCE, NOT A SEPARATE COMPLAINT - because the baby favours one side to sleep on, constant pressure on the head remodels the cheekbones, and facial hemihypoplasia or plagiocephaly follows. Treating the neck early is what prevents it - craniofacial asymmetry improves too, and improves most where treatment started early. WHEN PHYSIOTHERAPY IS NOT ENOUGH - a collar is an option later: the TOT collar - Tubular Orthosis for Torticollis - is recommended once a child is over 4 months of age. Surgery comes last, and may be indicated where 6 months of manual stretching has produced no improvement. Refer rather than keep stretching indefinitely. WHAT TO TELL THE PARENTS - come back to the paediatrician, or to the physiotherapist, on noticing any swelling of the neck muscles, or any deformity of the neck. Say why it matters: a diagnosis made late can end in surgery, and the asymmetry of the face and skull can persist. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)