OBJECTIVE

To know the definition of torticollis,

especially the congenital muscular
torticollis (CMT)
To know the sign and symptom of CMT
Can do the first management for CMT
Can refer the CMT case for advance
treatment

Retno Setianing

INTRODUCTION
Congenital muscular torticollis or
sternocleidomastoid torticollis is a
condition that occurs at birth or up to 2
months of age, where the childs head is
tilted to one side.
The other term for this condition is wryneck.

INTRODUCTION

This clearly should be differentiated from many

other congenital and acquired types of torticollis
such as :
congenital cervical vertebral anomalies, post
traumatic infections and inflammation of
adjacent structures, neoplastic conditions, and
miscellaneous types of structural and functional
neurological causes.

SYMPTOM of Torticollis
In infants with torticollis, the head
typically is tilted toward the side of the
affected muscle and rotated toward the
opposite side. In many cases, a mass or
tumor can be palpated in the involved
muscle.
Skull and facial asymmetry or
plagiocephaly also may be present

Whats the caused ?

CMT is caused by damage to or a

shortening of the sternocleidomastoid in an
infants neck.
Sometimes, but not in all cases, there is a
hematoma (lump) in the muscle where it
was damaged. That lump will eventually go
away as the muscle heals and is stretched.
The most common causes of CMT are
inutero positioning, lack of space inutero
(big baby or little mom), a traumatic birth,
multiples (lack of room again!), and low
amniotic fluid inutero.

What Can We Do ?
Positioning
Stretching
Orthosis
Surgery

POSITIONING

POSITIONING

PRONE IN THE TUMMY AND PLAY

FROM THE LEFT IF THE CHILD HAVE
LEFT TORTICOLLIS

STRETCHING

torticollis with this head tipped towards his left side

Exercises involve gently

rotating his head to the
left

gently stretching his head and neck towards the right

Hold the position for 10 seconds. Repeat 15 times,
4 to 6 times a day.

The mainstay of treatment is stretching exercises to stretch the

contracted sternomastoid muscle 15 to 20 times, 4 to 6 times a day.

STRETCHING

torticollis with this head tipped towards his

right side

Exercises involve gently

gently stretching his head and neck towards the left
rotating his head to the
right
Hold the position for 10 seconds. Repeat 15
times, 4 to 6 times a day.

ORTHOSIS

TOT Collar (Tubular Orthosis for Torticollis)

INDICATION & PRECAUTION

The collar is used for infants who are 4 months or older,
show a consistent head tilt of 5 degrees or more. They
should already have adequate ROM and have head
control. The infant MUST be supervised at all times while
wearing the collar. They should wear it only when awake
and active. The collar should not be used on a child in a car
seat.

the TOT is easiest to use and most effective right after a

child begins sitting and can be used until they are walking.
The TOT should be fit and often has to be re-fit after
considerable growth.

PROGNOSIS
When discovered early, and stretching exercises
and positioning followed consistently, 80% recover
completely with no long-term effects.
In some cases that do not respond to exercises by
age 1, surgical release of the sternomastoid muscle
may be required.

SURGERY INDICATIONS
Patients with significant head tilt and deficits of
passive rotation and side flexion of the neck greater
than 10 to 15 and the presence of tight band or
tumor in the SCM.
They either have not responded to or improved
additionally after at least 6 months of physiotherapy
manual stretching

Multi-adjustable post-operative orthosis

for congenital muscular
torticollis

The orthosis was only removed for

the purpose of an intensive active mobilisation
and passive stretching physiotherapy
programme which was begun once the surgical
wound had healed (five to seven days
The total period of orthosis wear
ranged from 8 to 12 weeks