Infant torticollis or wry neck, which is observed at birth or within the first few weeks following birth, is known as congenital torticollis. The ideologies are many, and it is critical initially to differentiate variety of pathological causes prior to applying chiropractic treatment.
Comprehensive case history and examination, including neurological an orthopedic evaluation is essential in determining whether the torticollis is primarily musculo-skeletal, and therefore biomechanical in nature. The diagnoses to eliminate include traumatic fractures of the cranium, cervical vertebrae, sternum or clavicles, tumors are neoplasms of the brainstem, spinal cord, vertebral column and related soft tissue structures, congenital anomalies of the cranium and cervical vertebrae, and infections of the brainstem, spinal cord, vertebral column and cervico-thoracic soft tissues.
Torticollis is characterized by unilateral hypertonicity or spasm of the sterno-cleido-mastoid (SCM) muscle, often associated with a palpable mass due to the fibrotic contracture or hematoma in the belly of the muscle.
The etiologies are diverse. The most common cause is in-utero constraint, a traumatic event during the descent of the baby through the birth canal, or the application of forceps or vacuum extraction during the delivery process. The frank breech presentation is associated with a high incidence of torticollis, up to 34% of infants born in this position being affected.
The case history and/or referral mechanism is frequently attributed to a baby that prefers nursing from one breast only, with extreme fussiness and agitation on the other side. But all other potential breast-feeding problems have been eliminated, chiropractic spinal examination may prove revealing to a diagnosis of torticollis.
Parents may often observed that the infant has a favorite head position when sleeping or lying in the car seat, and this is a valuable question to be asked in the case history for every child. Torticollis may not always be visually observed by the parents or caregivers, and a line of questioning to eliminate the possibility should be routine in any case history.
It is also a value to inquire of the parents whether or not the infant is sensitive to touch around the neck and suboccipital areas. Additionally, although the biomechanical patterns for congenital torticollis may exist at birth, there may be no visual indications until the infant attempting to raise and maintain its head somewhat upright, certainly not until 2 to 4 weeks of age, sometimes later. Therefore, in all likelihood, the astute chiropractor maybe the first healthcare provider to identify the torticollis in the early days and weeks.
The clinical picture is most often that of the infant’s head laterally flexed towards the involved side, with con-commitment rotation towards the opposite shoulder. There may or may not be a presentation of cranial and facial moulding, most commonly brachioplagiocephaly where there is flattening of the occiput, parietal, and temporal bones unilaterally, and sometimes associated mandibular asymmetry.
Using a measuring tape, measure from the external occipital protuberance around to the midline of the frontal bone at the top of the nose, comparing the two sides, left and right, in distance. Confirm accuracy of your measurements by measuring the entire circumference of the head, the total of which should be equal to the sum of your two measurements for left and right.
Upon passive range of motion testing, the infant maybe a rigid in the affected ranges of motion, or expressed discomfort and distress to even light palpation attempt to move the head and neck. Segmental motion palpation is useful in determining the primary affected spinal segments.
Scientific research illustrates cervical spine involvement to be present in as many as 50% of cases of congenital torticollis. The most commonly involved segments are C-O C-1 C-2, displaying a subluxation pattern of C1 anterior rotation on the opposite side of SCM contracture.
The upper thoracic segments are often biomechanically compromised as well, examination of compensatory subluxation complex. Gentle suboccipital traction and stretching of the SCM muscle is a value clinically, and also taught as a home technique to the parents. This is performed by cautiously laterally flexing the infants neck to the side away from the torticollis, then gradually easing into rotation of the head towards the side of torticollis. This position can be held for 5 to 10 seconds, slowly released, and repeated 3 to 5 times during each session. They should only be performed on the infant is calm and relaxed, not one hungry nor fussy. Repeat the process every 3-4 hours.
This short article is not exhaustive of the information known about congenital torticollis. A specific chiropractic evaluation, by a trained chiropractor, can be the first step in assessing and correcting the underlying cause of the infant’s torticollis.