The clinical presentation and outcome of treatment of congenital muscular torticollis in infants—A study of 1,086 cases


      Background/Purpose: The main objectives of this study were to define the clinical patterns and characteristics of congenital muscular torticollis (CMT) presented in the first year of life and to study the outcome of different treatment methods. Methods: This is a prospective study of all CMT patients seen in 1 center over a 12-year period with uniform recording system, assessment methods, and treatment protocol. Results: From a total of 1,086 CMT infants, 3 clinical subgroups of sternomastoid tumor (SMT; 42.7%), muscular torticollis (MT; 30.6%), and postural torticollis (POST; 22.1%) were identified. The SMT group was found to present earlier within the first 3 months and was associated with higher incidence of breech presentation (19.5%), difficult labor (56%), and hip dysplasia (6.81%). Severity of limitation of passive neck rotation range (ROTGp) was found to correlate significantly with the presence of SMT, bigger tumor size, hip dysplasia, degree of head tilt, and craniofacial asymmetry. Conclusions: A total of 24.5% of the patients with initial deficits of passive rotation of less than 10° showed excellent and good outcome with active home positioning and stimulation program. The remaining cases with rotation deficits of over 10° and treated with manual stretching program showed an overall excellent to good results in 91.1% with 5.1% requiring subsequent surgical treatment. The most important prognostic factors for the necessity of surgical treatment were the clinical subgroup, the ROTGp, and the age at presentation (P <.001). J Pediatr Surg 35:1091-1096. Copyright © 2000 by W.B. Saunders Company.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Tubby AH
        ed 2. Deformities. vol 1. Macmillan, London, England1912
        • Canale ST
        • Griffin DW
        • Hubbard CN
        Congenital muscular torticollis.
        J Bone Joint Surg [Am]. 1982; 64-A: 810-816
        • Chandler FA
        • Altenberg A
        “Congenital” muscular torticollis.
        JAMA. 1944; 125: 476-483
        • Colonna PC
        Congenital torticollis.
        Virginia Medical Monthly. 1927; 53: 794-796
        • Coventry MB
        • Harris LE
        Congential muscular torticollis in infancy: Some observations regarding treatment.
        J Bone Joint Surg [Am]. 1959; 41-A: 815-822
        • Hulbert KF
        Congenital torticollis.
        J Bone Joint Surg [Br]. 1950; 32: 50-59
        • Lidge RT
        • Betchtol RC
        • Lambert CN
        • et al.
        Congenital muscular torticollis—Etiology & pathology.
        J Bone Joint Surg [Am]. 1957; 39-A: 1165-1182
        • Macdonald D
        Sternomastoid tumor and muscular torticollis.
        J Bone Joint Surg [Br]. 1969; 51-B: 432-443
        • Whitman R
        Observations on torticollis, with particular reference to the significance of the so-called haematoma of the sterno-mastoid muscle.
        Trans Am Orthop Assn. 1891; 4: 293-307
        • Middleton DS
        The pathology of congenital torticollis.
        Br J Surg. 1930; 18: 188-204
        • Jones PG
        Torticollis in infancy and childhood.
        in: Charles C. Thomas, Springfield, IL1968: 3-16
        • Engin C
        • Yavuz SS
        • Sahin FI
        Congenital muscular torticollis: Is heredity a possible factor in a family with five torticollis patients in three generations?.
        Plastic Reconstr Surg. 1997; 99: 1147-1150
        • Davis JR
        • Wenger DR
        • Mubarak SJ
        Congenital muscular torticollis: Sequela of intrauterine or perinatal compartment syndrome.
        J Pediatr Orthop. 1933; 13: 141-147
        • Cheng JC
        • Au AW
        Infantile torticollis: A review of 624 cases.
        J Pediatr Orthop. 1994; 14: 802-808
        • Ling CM
        • Low YS
        Sternomastoid tumor and muscular torticollis.
        Clin Orthop. 1972; 86: 144-150
        • Suzuki S
        • Yamamura T
        • Fujita A
        Aetiological relationship between congenital torticollis and obstetrical paralysis.
        Int Orthop. 1984; 8: 175
        • Binder H
        • Eng GD
        • Gaiser JF
        • et al.
        Congenital muscular torticollis: Results of conservative management with long term followup in 85 cases.
        Arch Phys Med Rehabil. 1987; 68: 222-225
        • Hummer Jr, CD
        • MacEdwen GD
        The coexistence of torticollis and congenital dysplasia of the hip.
        J Bone Joint Surg [Am]. 1972; 58: 1255
        • Iwahara T
        • Ikeda A
        On the ipsilateral involvement of congenital muscular torticollis and congenital dislocation of the hip.
        J Japanese Orthop Assn. 1962; 35: 1221
        • Walsh JJ
        • Morrissy RT
        Torticollis and hip dislocation.
        J Paediatr Orthop. 1998; 18: 219-221
        • Emery C
        The determinants of treatment duration for congenital muscular torticollis.
        Phys Ther. 1994; 74: 921-929
        • Ferkel RD
        • Westin GW
        • Dawson DG
        • et al.
        Muscular torticollis: A modified surgical approach.
        J Bone Joint Surg [Am]. 1983; 65: 894-899
        • Leung YK
        • Leung PC
        The efficacy of manipulative treatment for sternomastoid tumour.
        J Bone Joint Surg [Br]. 1987; 69: 473-478
        • McDaniel A
        • Hirsch BE
        • Kornblut AD
        • et al.
        Torticollis in infancy and adolescence.
        Ear Nose Throat. 1984; 63: 478-487
        • Cheng JCY
        • Tang SP
        Outcome of surgical treatment of congenital muscular torticollis.
        Clin Orthop. 1999; 362: 190-200