Torticollis

Overview

What is torticollis?

Torticollis is a condition where your baby’s neck muscles cause their head to twist and tilt to one side. It may look like your infant’s neck is rotated at an odd angle. The top of their head may be tilted to one side and their chin may be tilted to the other side.

Torticollis is also called wryneck. Torticollis comes from the Latin words “tortus,” which means twisted, and “collum,” which means neck. Torticollis is fairly common in babies and children. Torticollis may be present at birth (congenital). Or it may develop later in infancy or childhood (acquired).

Congenital torticollis is the most common type of torticollis. It’s usually painless to your infant. You may not notice it until your baby is a few weeks old. Once they start to gain more control of their head, you may spot it.

Acquired torticollis usually occurs in the first four to six months of your baby’s life or later. You may notice it suddenly or it may come on more slowly. Acquired torticollis may be harmless (benign) or it may be a sign of a more serious health issue.

Symptoms and Causes

What are the symptoms of torticollis?

Symptoms of congenital torticollis may include:

  • Your baby’s head tilts to one side and chin tilts to the other side.
  • Limited movement of your baby’s head and neck.
  • One of your baby’s shoulders is higher than the other.
  • Neck muscle tightness or stiffness.
  • Swollen neck muscles.
  • Small pea-sized lump in one of your baby’s neck muscles.
  • Uneven (asymmetrical) facial features.

Symptoms of acquired torticollis may include:

  • Your child’s head tilts to one side and chin tilts to the other side.
  • Limited movement of your child’s head and neck.
  • One of your child’s shoulders is higher than the other.
  • Neck muscle tightness or stiffness.
  • Swollen neck muscles.
  • Severe neck pain.
  • Head tremors.
  • Headaches.

What causes torticollis?

The shortening of one of your baby’s sternocleidomastoid muscles (SCMs) causes congenital torticollis. Your SCMs are two large muscles in your neck. They connect the back of your skull to your breastbone (sternum) and collarbone (clavicle). Researchers aren’t sure why one of these muscles shortens in some babies. It may be due to:

  • The way your baby was positioned in your womb (uterus).
  • An abnormal development in the SCM.
  • A collection of blood in your baby’s neck muscles (hematoma).
  • Abnormal thickening of your baby’s muscle tissue (fibrosis).
  • Klippel-Feil syndrome, a rare birth defect that causes the vertebrae in your baby’s neck to fuse.

Acquired torticollis frequently occurs because of swelling in your child’s throat. The swelling causes the tissues surrounding your child’s upper spine to loosen. This allows their vertebrae to move out of their normal position. This causes their neck muscles to spasm, causing their head to tilt to one side. The swelling may be due to an infection, an injury or an unknown reason. Other causes of acquired torticollis may include:

  • Gastroesophageal reflux (GERD).
  • Vision problems.
  • Reaction to certain medications.
  • Scar tissue.
  • Arthritis of the neck (cervical spondylosis).
  • Sandifer syndrome, a rare condition that combines GERD with neck spasms.
  • Grisel's syndrome, a rare complication of head and neck infections or ear, nose and throat (ENT) surgeries.

Diagnosis and Tests

How is torticollis diagnosed?

Your baby’s healthcare provider will perform a physical examination to diagnose torticollis. They’ll look at how far your baby’s head is twisted or tilted. They’ll also examine your baby’s neck and look for swollen or stiff muscles. Depending on the severity of the condition, your baby’s healthcare provider may order tests including:

Management and Treatment

How is torticollis treated?

Most often, stretching exercises and position changes can treat congenital torticollis. Your baby’s healthcare provider will teach you how to stretch your baby’s neck muscles. You’ll need to gently move your baby’s head to the opposite side. You’ll want to practice torticollis stretches several times a day. Over time, slowly increase the movements.

For position changes, lay your baby on their back with their head positioned to the opposite side during naps and at bedtime. When your baby’s awake, move toys and other objects so they have to practice turning their neck in the opposite direction.

If these methods don’t work, your baby’s healthcare provider may refer you to a specialist. They may first recommend physical therapy. Other specialists may include:

Physiatrist: A physiatrist is a doctor who specializes in physiatry, or physical medicine and rehabilitation (PM&R).

Pediatric neurologist: A pediatric neurologist is a doctor who specializes in brain, spinal cord and nerve disorders in children.

Orthopedic surgeon: An orthopedic surgeon is a doctor who specializes in the musculoskeletal system. Your baby may need surgery to lengthen their SCM muscle.

Treatment for acquired torticollis focuses on the condition causing it and relieving symptoms. Treatment may include:

Prevention

How can I prevent torticollis?

There’s no known way to prevent torticollis. But early treatment can help prevent your baby’s condition from getting any worse. And it may prevent your baby from needing surgery later.

Start torticollis stretches with your baby within a few months of their birth. If you start quickly, you can also prevent the possibility of any long-term complications.

Outlook / Prognosis

What can I expect if my child has torticollis?

Torticollis is a fairly common condition in babies and children. Stretching your baby’s neck and repositioning your baby’s head can typically treat the condition. Within a few months, you should start to see some improvement in your baby. They shouldn’t have any long-term issues if treatment starts early.

What are the possible complications of torticollis?

If your baby has torticollis, they may develop a deformity on their face due to the lack of muscle movement. Another complication that may occur is flat head syndrome (plagiocephaly). Your baby’s skull is soft and moldable. When they rest the same section of their head on a surface too often, the pressure can flatten that section of their head.

Living With

When should I call my baby’s healthcare provider?

If stretching exercises and position changes don’t improve your baby’s condition, call their healthcare provider. They may need further treatment to correct the issue.

Frequently Asked Questions

What is spasmodic torticollis?

Spasmodic torticollis is a type of torticollis that occurs in adults. It’s also called cervical dystonia. Spasmodic torticollis causes your neck muscles to contract in spasms. This causes your head to twist painfully to one side. It can also cause your head to tilt forward or backward uncontrollably. There’s no cure for spasmodic torticollis. Injections of botulinum toxin sometimes treat the condition.

What is acute torticollis?

Acute torticollis occurs suddenly when you wake up with pain and stiffness down one side of your neck. The stiffness causes your neck to twist to one side. Minor neck sprains or irritations of the neck muscles can cause acute torticollis. The condition typically doesn’t require medical treatment. Pain relievers usually resolve symptoms.

A note from Cleveland Clinic

If your baby’s head is twisted or tilted to one side, it may be an upsetting sight. But torticollis in infants typically doesn’t cause them any pain. The condition can usually be treated with stretches and positioning. If you find that these at-home exercises and other treatments aren’t working, contact your baby’s healthcare provider. They’ll be able to determine if your baby needs additional treatment.

Last reviewed by a Cleveland Clinic medical professional on 02/28/2022.

References

  • American Academy of Pediatrics. Head Tilt (Torticollis). (https://www.healthychildren.org/English/health-issues/conditions/Cleft-Craniofacial/Pages/Head-Tilt.aspx) Accessed 2/25/2022.
  • Cunha B, Tadi P, Bragg BN. Torticollis. (https://www.ncbi.nlm.nih.gov/books/NBK539857/) [Updated 2021 Sep 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Accessed 2/25/2022.
  • MedlinePlus. Torticollis. (https://medlineplus.gov/ency/article/000749.htm) Accessed 2/25/2022.
  • Merck Manual. Congenital Torticollis. (https://www.merckmanuals.com/home/children-s-health-issues/birth-defects-of-the-face,-bones,-joints,-and-muscles/congenital-torticollis) Accessed 2/25/2022.
  • National Center for Advancing Translational Sciences: Genetic and Rare Diseases Information Center. Congenital torticollis. (https://rarediseases.info.nih.gov/diseases/4908/congenital-torticollis) Accessed 2/25/2022.

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