Congenital Muscular Torticollis — Physical Exam Features of CMT — Clinical Pathway: Outpatient Specialty Care and Primary Care

Congenital Muscular Torticollis Clinical Pathway — Outpatient Specialty Care and Primary Care

Physical Exam Features of CMT

  • Head tilt to ipsilateral side of tight sternocleidomastoid muscle (SCM)
  • Restricted cervical range of motion (ROM)
    • Restricted cervical rotation to ipsilateral side of head tilt or SCM tightness
    • Restricted cervical lateral flexion to contralateral side of head tilt due to SCM tightness
  • Preference for cervical rotation to one side
  • Mass or thickening of sternocleidomastoid muscle (SCM)
  • Plagiocephaly present (unilateral head flattening)

History and Physical Exam

  • Types of torticollis that may be present
    • Postural torticollis: postural preference of cervical spine with no muscle tightness or restriction to passive ROM
    • Muscular torticollis: muscular tightness of SCM and limitations of ROM of cervical spine
    • Sternomastoid tumor torticollis: muscular tightness and limitations of ROM of cervical spine as well as SCM thickening or fibrosis
  • A restriction in cervical range of motion may cause significant functional impairment to gross motor development as well as visual awareness of surroundings
  • Common etiology includes:
    • Intrauterine compartment syndrome
    • Birth trauma
    • Hereditary factors
    • Rupture of muscle
    • Intrauterine malposition
    • Deformational plagiocephaly
General
  • Detailed birth history
    • Pregnancy
    • Gestational age
    • Weight
    • Delivery method
    • History of birth trauma
    • Newborn history
Torticollis History
  • Age of onset
  • Head tilt preference
  • Positional preference
Head and Neck Exam
  • Neck:
    • Range of motion
      • Cervical rotation
      • Cervical lateral flexion
    • Palpate SCM
  • Oculomotor:
    • Visual tracking
  • Features of CMT:
    • Head tilt
      • Typically associated with tightness of ipsilateral SCM
    • Cervical rotation preference
      • Typically rotated to side contralateral to head tilt
      • Difficulty rotating to side of SCM tightness
    • Fibrotic mass within SCM
  • Craniofacial Assessment:
    • Head size
    • Head shape
      • Plagiocephaly may be present with flattening typically of side ipsilateral to preferred rotation
    • Closure of fontanelles
  • Possible Associated Findings:
    • Trunk curvature
    • Asymmetrical use of upper extremities
    • Plagiocephaly
    • Hip Dysplasia
      • Special tests: Ortolani, Barlow, Galeazzi, gluteal folds
    • Brachial plexus palsy
  • Left Torticollis:
    • Head tilt to left, rotation to right
Left Torticollis: Head tilt to left, rotation to right
  • Right Torticollis:
    • Head tilt to right, rotation to left
Right Torticollis