Congenital torticollis (wry neck)

Specialty of Paediatric surgery

What is congenital torticollis?

Torticollis, also known as wry neck, is a condition in which the patient’s neck is abnormally twisted, leaving the head at an asymmetrical angle. It is often painful and difficult to turn the head from this position.

There are two categories of torticollis: acquired and congenital. Congenital means the patient was born with the condition. While acquired torticollis can be caused by a number of things, from scarring of the muscle tissue to swollen lymph nodes, congenital torticollis usually occurs because the infant’s sternocleidomastoid muscle, which runs down the side of the neck, is too short and tight.

Prognosis of congenital torticollis

In most cases, congenital torticollis can be overcome with time if treated correctly with stretching exercises and simple changes in how the baby is held.

Symptoms of congenital torticollis

The key symptom is the position of the head – tilted to one side with the chin pointing towards the opposite shoulder. In three out of four babies with wry neck, the right side of the neck is affected. Other symptoms include:

  • Limited range of movement in the head and neck.
  • A soft lump may be felt in the baby’s neck during the first few weeks after birth, which gradually disappears. It does not seem to cause the baby pain.
  • One side of the face may flatten due to the baby sleeping on the same side all the time.

Congenital muscular torticollis is usually noticed within the first six to eight weeks after birth, as the baby gains more control over its body, but struggles with its head and neck.

A number of infants born with wry neck also have developmental hip dysplasia. This is a condition where the thigh bone fits loosely in the joint and may easily pop out of the hip socket.

What are the causes of congenital torticollis?

The exact cause of wry neck is unclear, but it is thought by some to be related to the baby’s position in the uterus or during birth, which injures the neck muscle. Congenital torticollis seems to be more common in first-borns, who have less space in the womb than their later siblings.

Treatments for congenital torticollis

Treatment can depend on the age of the child and the severity of the condition. In most cases, the first line of treatment is a regime of stretching exercises to lengthen the baby’s sternocleidomastoid muscle. This generally involves the parent gently turning the baby’s head, as instructed by a doctor or physical therapist.

The baby can also be encouraged to practise stretching the muscle by positioning toys so they have to turn their head to see them, or sitting on their limited side so they have to turn to look at you.

In around 10% of cases, these conservative methods are not successful, and surgery may be recommended.

Which type of specialist treats congenital torticollis?

Paediatricians, paediatric physical therapists, and paediatric surgeons may be involved in the treatment of congenital torticollis.

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