PediatricUnresolved Congenital Torticollis and Its Consequences: A Report of 2 Cases
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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Cited by (2)
Nontraditional Therapies (Traditional Chinese Veterinary Medicine and Chiropractic) in Exotic Animals
2018, Veterinary Clinics of North America - Exotic Animal PracticeCitation Excerpt :Torticollis or wryneck has been documented in several species. In the human literature, there are many case reports of chiropractic improving or resolving torticollis.24–29 In the veterinary literature, there is a case of successful management of acute-onset torticollis acquired during shipping in a 2-year-old giraffe (Giraffa camelopardalis reticulate).30
Congenital Muscular Torticollis—Current Understanding and Perinatal Risk Factors: A Retrospective Analysis
2024, Healthcare (Switzerland)