From the Guidelines
Torticollis in infants can be tested through a combination of physical examination and imaging studies, with the primary method involving observation of the infant's head position and assessment of the sternocleidomastoid muscle. The physical examination is crucial as it allows healthcare providers to identify characteristic signs such as a tilt to one side with rotation to the opposite side, palpable mass or tightness in the sternocleidomastoid muscle, limited range of motion in the neck, and asymmetry in the head shape (plagiocephaly) 1.
Key Examination Components
- Observation of the infant's head position to identify any characteristic tilt
- Palpation of the sternocleidomastoid muscle to check for tightness or masses
- Assessment of the infant's range of motion in the neck
- Evaluation for asymmetry in the head shape
Additional tests may include ultrasound to visualize the sternocleidomastoid muscle for thickening or masses, and in some cases, X-rays to rule out skeletal abnormalities 1. It's essential to note that while the provided study focuses on ataxia, the principles of physical examination and the importance of early diagnosis and intervention apply to torticollis as well. Early diagnosis is critical as treatment is most effective when started before three months of age, typically involving gentle stretching exercises, positioning techniques, and occasionally physical therapy. Parents should seek medical evaluation if they notice their infant consistently holding their head tilted to one side, as early intervention leads to better outcomes and can prevent complications like permanent limited neck mobility or facial asymmetry.
From the Research
Diagnosis of Torticollis in Infants
- Torticollis in infants can be diagnosed through physical examination and medical history, with congenital muscular torticollis (CMT) being the most common form of torticollis in children 2.
- CMT may present as a palpable sternomastoid tumor (SMT) or a simple tightness of the sternocleidomastoid muscle (SCM), designated as idiopathic muscular torticollis (IMT) 3.
- The diagnosis of torticollis in infants involves ruling out other possible causes, such as ocular torticollis, Sandifer's syndrome, neural axis abnormalities, and benign paroxysmal torticollis 2.
Testing for Torticollis in Infants
- There is no specific test mentioned in the provided studies for diagnosing torticollis in infants, but physical examination and medical history are used to diagnose the condition 3, 2.
- The studies focus on the treatment of torticollis in infants, including the use of botulinum toxin and physical therapy 3, 4.
- It is essential to differentiate between congenital muscular torticollis and other causes of torticollis in infants, as the treatment approach may vary depending on the underlying cause 2.
Treatment and Management
- The treatment of torticollis in infants typically involves physical therapy, including manual cervical stretching, and may also include the use of botulinum toxin injections in cases where physical therapy is not effective 3, 4.
- In some cases, surgical release of the sternocleidomastoid muscle may be necessary, but this is typically considered a last resort 3, 2.
- The use of botulinum toxin injections has been shown to be effective in treating congenital muscular torticollis in infants, with significant improvement in head tilt and range of neck motion observed in studies 3, 4.