Disease Description (Causes and Symptoms)
Congenital torticollis (congenital sternocleidomastoid muscular torticollis) is a condition in which one sternocleidomastoid muscle (SCM) is shortened and fibrotic at birth or during the neonatal period, causing the head to tilt toward the affected side (lateral flexion) and the chin to turn toward the opposite side. The main underlying mechanism is muscle shortening due to fibrosis following intramuscular bleeding and necrosis caused by the position in the uterus or during delivery; rarely, cervical vertebral abnormalities may be the cause. It occurs in approximately 1–2% of newborns.
Main Symptoms
- A firm lump palpable on the front of one side of the neck (appears around 2–4 weeks after birth and commonly disappears within 2–6 months after birth)
- Persistent tilting of the head (toward the shortened side) and limited rotation
- Facial asymmetry (flattening) — if left untreated for a long time, fixed changes in appearance may develop
- Asymmetry of neck movement due to restricted motion
Diagnosis is primarily based on the medical history and physical examination (head tilt, assessment of SCM shortening and palpation of the lump). If necessary, ultrasonography (to differentiate a muscle mass), cervical spine radiographs (to identify abnormalities), an eye examination (to differentiate strabismus), and tests to check for developmental dysplasia of the hip may also be performed.
Treatment Methods (Standard Treatment, Medications·Procedures·Surgery, Lifestyle Management) and Precautions
The principle of treatment is early conservative treatment (stretching and postural correction) → surgical muscle lengthening/resection if the response is insufficient.
Non-surgical Treatment (First Choice)
- Daily stretching under parent or caregiver instruction: 3–4 times per day, for an appropriate amount of time during each set (with demonstration and instruction by a physical therapist), stretching the shortened SCM in the opposite direction.
- Encouraging therapeutic positioning during sleep and feeding (guiding the baby’s gaze and correcting head position)
- Physical therapy (manual therapy under professional guidance and exercises for infants)
Surgical Treatment (When Non-surgical Treatment Fails)
- Partial or complete lengthening/resection of the SCM (increasing muscle length)
- Maintaining the corrected position with a brace or cast, followed by resumption of active and passive exercises
- Results are generally good when performed before 4–5 years of age; in older children, complete correction of facial deformity may be difficult
Precautions and Risk of Complications
- Starting treatment early (within several weeks to months after birth) is important for the prognosis: when started within 2–3 months, improvement of more than approximately 80% with conservative treatment alone has been reported
- Excessive stretching may cause pain or injury — always follow the physical therapist’s instructions
- Surgical complications: nerve injury (for example, nerves around the sternocleidomastoid muscle), infection, scarring, etc.
- If left untreated, fixed facial asymmetry, shoulder elevation, and scoliosis may develop
- Associated conditions (developmental dysplasia of the hip, cervical spine abnormalities, and strabismus) should be checked
Self-management Points
- Perform regular stretching at the prescribed frequency and using the prescribed method
- Record photographs of treatment progress and changes in posture (useful when consulting a doctor)
- Visit a medical institution immediately if pain, fever, or an acute change in the lump develops during treatment
Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)
Items to Bring
- List of currently used medications and supplements (if applicable)
- Previous medical records and test results (such as ultrasonography and radiographs)
- Records of when treatment was started and the stretching performed by time of day and day (frequency and duration)
- Records of observations related to the baby’s feeding and sleeping habits and development (lifting the head, rolling over, etc.)
- Records of when symptoms began and how they changed (photos or videos recommended)
Things to Show the Doctor During the Visit
- Photos and videos clearly showing changes in head tilt (from multiple time points)
- Records of changes in the size of the palpable lump
Example Questions to Check Before the Outpatient Visit (Self-check)
- Has the size or firmness of the lump suddenly increased?
- Does the baby appear to be in pain (affecting sleep or feeding)?
- Are other physical problems present, such as a difference in leg length, an abnormal gait, or hip problems?
Examples of General Questions to Ask the Doctor
- What is this child’s prognosis? How much improvement can be expected with treatment?
- What is the specific method for stretching treatment (frequency and position)?
- When is surgery needed, and what is the recovery process after surgery?
- What complications and risks are expected with surgery?
- Are any additional tests needed (for the hips, cervical spine, eyes, etc.)?
Examples of Condition-specific Questions
- How many months does a baby’s sternocleidomastoid muscle lump usually take to disappear? If the lump remains, how does this change the situation?
- Exactly what position should be used for stretching at home, and for how long and how many times should it be performed? (A demonstration from a physical therapist is planned, but request specific instructions.)
Brief Summary
- Early diagnosis and early stretching are very important, and most cases improve with non-surgical treatment.
- If atypical findings are present (rapid growth, pain, suspected cervical spine abnormalities, or suspected associated conditions), additional testing or evaluation by other departments (orthopedics, pediatric rehabilitation medicine, or ophthalmology) is needed.