Pediatric
Unresolved Congenital Torticollis and Its Consequences: A Report of 2 Cases

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Abstract

Objective

The purpose of this report was to describe the clinical presentation and case management of 2 children with congenital torticollis.

Clinical Features

Two male children (ages 6 and 10 years) presented to a chiropractic clinic with a history of congenital torticollis. They showed signs and symptoms of postural deficiency and developmental delay: posterior plagiocephaly, facial scoliosis, head tilt, compensatory thoracic scoliosis, decreased range of motion in the cervical spine, palpable decreased segmental motion of the upper cervical spine, and an age-related delay in throwing and catching a ball and in one-leg standing.

Intervention and Outcome

Both children received chiropractic care (spinal manipulative therapy) and physical therapy (therapeutic exercises, including neck, back, and coordination exercises). Each patient responded favorably with improvement in both structural (posture) and functional (range of motion of the spine and coordination) deficits.

Conclusions

Both patients responded favorably to the combined therapy. These findings suggest that children with congenital torticollis may benefit from a treatment plan that includes a broad therapeutic approach based on the principles of biomechanics and sensorimotor development.

Introduction

The incidence of congenital torticollis ranges from 0.3% to 16% and is a condition warranting evaluation and treatment at an early stage.1,2 Congenital torticollis typically stems from a musculoskeletal problem or an underlying nonmusculoskeletal pathology and is characterized by a head and neck tilt, often combined with a rotational preference of the neck.3,4

Classic congenital orthopedic torticollis, mainly referred to as congenital muscular torticollis, is a nonparoxysmal torticollis with involvement of the sternocleidomastoid (SCM) muscle with a pseudotumor in the SCM.3, 4, 5 The literature has reported on nonparoxysmal, musculoskeletal torticollis such as postural torticollis. In this type of torticollis, an imbalance in the neck musculature may be present.6,7 Furthermore, nonparoxysmal torticollis may be caused by dysfunction in the upper cervical spine, and is sometimes referred to as kinematic imbalance caused by suboccipital strain (KISS).8 Both postural torticollis and KISS may be observed in infants and have an unknown etiology. Postural torticollis usually has decreased active range of motion (ROM) but normal passive ROM, whereas torticollis with SCM involvement and KISS show decreased active and passive ROM.2,4,8 All 3 types of torticollis can lead to secondary changes in shape, such as deformational plagiocephaly (DP), facial scoliosis, and infantile scoliosis, and functional problems, including unilateral breastfeeding problems and asymmetrical use of the hands.3,4,8 In addition to this, in the last decade, the question of whether congenital torticollis can lead to a delay in gross motor and coordinative development in infants, preschool children, and schoolchildren has gained increasing interest among clinicians and researchers.2,5,8

The consequences of congenital torticollis that is still present in school-aged children have been only vaguely described in the literature. Therefore, the purpose of this article is to describe the clinical presentation and case management of 2 children with congenital torticollis.

Section snippets

Case Report

The 2 patients were seen at a private chiropractic clinic in Switzerland. The parents gave informed consent to publish this report.

Discussion

The 2 children described in this article responded positively to combined chiropractic care and physical therapy. The treatment outcome consisted of improvements in posture, increased active and passive ROM in the neck, and improved motor and coordinative skills. This suggests a possible spinal mechanical cause of the torticollis in these patients. Furthermore, it was suspected that there could be a relationship between developmental delay at school age and congenital torticollis.

Some authors

Conclusions

Two children with congenital torticollis, both of whom displayed delay in gross motor skills at school age, responded positively to combined chiropractic care and physical therapy with improvements in posture, increased active and passive ROM in the neck, and improved motor and coordinative skills. This case series suggests that children with congenital torticollis may benefit from a treatment plan that includes a broad therapeutic approach based on the principles of biomechanics and

Acknowledgments

The author thanks Dr. Cynthia Peterson and Dr. Johanna McChurch-Forrer for their review and comments, and the Anglo European College of Chiropractic for permission to publish this retrospective case series. This case series constitutes part of the requirements for a postgraduate Master’s degree in Advanced Professional Practice (Pediatric Musculoskeletal Health) at the Anglo-European College of Chiropractic, Bournemouth, United Kingdom.

Funding Sources and Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

Contributorship Information

Concept development (provided idea for the research): M.H.S.

Design (planned the methods to generate the results): M.H.S.

Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): M.H.S.

Data collection/processing (responsible for experiments, patient management, organization, or reporting data): M.H.S.

Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): M.H.S.

Literature search (performed

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