What is Congenital Muscular Torticollis (CMT)?

Definition:“Postural deformity detected at birth or shortly after birth, primarily resulting from unilateral shortening and fibrosis of sternocleidomastoid muscle(SCM).”

Sternocleidomastoid attached from just below the ear to the clavicle.

The Sternocleidomastoid (SCM), while the most common involved muscle, may not be the only involved structure. Other muscles of the side of the neck can be involved on the same side of the neck. (Example: scalenes, levator and/or upper trapezius)

What Causes Congenital Muscular Torticollis?

Torticollis is most commonly attributed to fetal positioning and intrauterine crowding

Increased incidence with first born, breech and multiple births
Does not appear to have a strict genetic link
Less commonly attributed to birth trauma

Increasing numbers of reported torticollis may be due to preventative measure for Sudden Infant Death Syndrome (SIDS). Introduction of “Back to Sleep” in 1994 has been shown to have increased the incidence of CMT and plagiocephaly

Fear of SIDS has resulted in parents avoiding prone positioning
As a result, babies will rotate head preferentially to one side due to poor head/neck control
This will result in progressive shortening of SCM and flattening of the skull
Parents are advised to begin prone positioning (“Tummy Time”) frequently and at a young age
This will also improve baby’s strength and development of righting reflexes

Signs and Symptoms of Congenital Muscular Torticollis:

Most commonly results in:

Head tilt to affected side
Ear close to shoulder
Face rotated to unaffected side

Rotation may differ if additional muscles are involved. This presentation is more common in older children with improved head and neck control.

CMT will usually present from birth to one year, however, two predominant time frames are:

Immediately after birth
2-4 months

Torticollis has more widespread effects than just the head and neck:

Decreased visual tracking towards unaffected side
Decreased use of unaffected Upper Extremity
Impaired awareness and development of mid-line
Impaired sitting balance
Impaired transitions
Impaired ability to tolerate prone positioning
Impaired weight bearing and weight shifting (Toe Walking)
Impaired postural and balance control
Head shape (Plagiocephaly)

For more information about CMT and Plagiocephaly treatment watch the videos below and click here Congenital Muscular Torticollis: Evaluation and Treatment

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