Congenital Torticollis

BySimeon A. Boyadjiev Boyd, MD, University of California, Davis
Reviewed/Revised Sept 2022
VIEW PROFESSIONAL VERSION

Congenital torticollis is a birth defect in which the head becomes tilted at or soon after birth.

Birth defects, also called congenital anomalies, are physical abnormalities that occur before a baby is born. "Congenital" means "present at birth." (See also Introduction to Birth Defects of the Face, Bones, Joints, and Muscles.)

The most common cause of congenital torticollis is

  • Injury to the baby's neck during delivery

The injury may damage neck muscles and/or cause a collection of blood (hematoma) in the neck muscles. These can lead to an abnormal thickening of neck tissue (fibrosis) and neck muscle stiffening (contracture). Very rarely, bones of the spine (vertebrae) are broken or dislocated during birth.

Other causes of torticollis that develop within the first few days or weeks of life include congenital spinal abnormalities such as

  • Klippel-Feil syndrome (fusion of the vertebrae in the neck, a short neck, and a low hairline)

  • Atlanto-occipital fusion (which is fusion of the first vertebra to the bottom of the skull)

Diagnosis of Congenital Torticollis

  • A doctor's evaluation

  • Usually x-rays

To diagnose the defect, doctors do a physical examination. They also do imaging tests, such as x-rays of the bones of the neck and shoulders, to look for problems.

Treatment of Congenital Torticollis

  • Depends on the cause

  • Rotating the head and stretching the neck

  • Sometimes injection of botulinum toxin

Treatment of torticollis caused by neck muscle injury includes rotating the head and stretching the neck. When torticollis is difficult to treat, doctors inject botulinum toxin into the stiffened neck muscle. The injections relax the stiff muscle.

Injuries and abnormalities of the vertebrae may need to be stabilized by surgery.

Because abnormal genes may be involved in the formation of congenital torticollis, affected families may benefit from genetic counseling.

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