From the Research
The most appropriate next step in management for this 4-week-old female infant with a neck mass and torticollis is ultrasonography of the neck (option E). This infant presents with classic findings of congenital muscular torticollis, likely due to birth trauma during her prolonged labor and forceps delivery. The head tilt to the left with chin deviation to the right, along with a hard, nontender mass in the sternocleidomastoid muscle, strongly suggests a sternocleidomastoid hematoma or fibrosis. Ultrasonography is the preferred initial imaging modality as it can confirm the diagnosis by visualizing the fibrotic mass within the muscle, rule out other causes of neck masses, and is non-invasive and radiation-free, making it ideal for infants, as supported by the latest research on the application of ultrasonography in the diagnosis and treatment of children with congenital muscular torticollis 1. Once the diagnosis is confirmed, treatment typically involves gentle stretching exercises and physical therapy, as recommended by the 2024 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association Academy of Pediatric Physical Therapy 2. Surgery is rarely needed and would be premature at this stage. Antibiotics are unnecessary as this is not an infectious process, and observation alone without intervention could lead to progressive torticollis and facial asymmetry. The importance of early identification and intervention to maximize outcomes in congenital muscular torticollis is also emphasized in recent studies 3, 4, highlighting the need for prompt and appropriate management to prevent long-term consequences.