🦴 Section 721.1 · Torticollis

Nelson Textbook of Pediatrics 22nd Edition | Torticollis (wryneck, cock-robin deformity): head tilted to one side, chin rotated to opposite side. Congenital muscular torticollis (CMT) — most common cause, due to SCM contracture (right > left). Palpable mass (fibromatosis colli) in 50%. Associated with DDH (8-20%) and plagiocephaly. Treatment: physical therapy (stretching) within first 3 months → near 100% resolution. Surgical release if persists >12-18 months. Other causes: Grisel syndrome (atlantoaxial rotatory displacement after URI), cervical anomalies (hemivertebra, Klippel-Feil), posterior fossa tumor, Sandifer syndrome.

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📋 30 Clinical Scenarios — Torticollis

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🩺 Clinical Recognition: Torticollis

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📋 Stepwise Management of Torticollis

🔑 Key Principles — Nelson Section 721.1
• Congenital Muscular Torticollis (CMT): SCM contracture. Head tilt to ipsilateral side, chin to contralateral side. Palpable mass in 50% (fibromatosis colli). Right SCM involved in 75%.
• Associated conditions: Plagiocephaly (flattening of contralateral occiput), DDH (8-20%), metatarsus adductus (15%), calcaneovalgus feet.
• Treatment: Physical therapy/stretching within first 3 months → near 100% resolution. Surgical release (unipolar or bipolar) if persistent >12-18 months.
• DDH screening: Hip ultrasound at 6 weeks (even if exam normal) due to high association.
• Other causes: Grisel syndrome (post-infectious atlantoaxial rotatory displacement), cervical hemivertebra, Klippel-Feil, posterior fossa tumor, Sandifer syndrome (GERD).

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: Torticollis (Nelson 721.1)