Wryneck/Torticollis

A torticollis is understood to be a torticollis of the head. This malposition can be congenital or acquired. A congenital muscular torticollis, which is usually already visible in infancy, is in almost all cases due to a malformation of the sternocleidomastoid muscle.

The causes of this form of torticollis are not yet fully understood. However, undersupply of blood to the muscle during pregnancy and muscle injuries and bleeding during birth are discussed as causes. Furthermore, an unfavorable position of the child in the womb can contribute to the development of a torticollis.

It has been observed that the torticollis often occurs in combination with other malformations such as clubfeet or hip dysplasia. The sternocleidomastoid muscle is shortened in this congenital form of the disease. In addition, muscle tissue is replaced by connective tissue, which is less elastic and cannot replace the functions of the muscle tissue.

The danger of congenital muscular malformation is that the spine tries to adapt its position to the constant head posture. Over time, those affected very often develop so-called scoliosis, which is a curvature of the spine. Due to the constant tension that is exerted on the malformed muscle, some of those affected suffer a tear and, as a result, bleeding into the remaining muscle.

This results in a bruise, known as a hematoma, in this muscle. The nodding hematoma is usually palpable in children as a small swelling below the ear. If the presence of a torticollis is suspected, a physiotherapeutic treatment should be started immediately with the infant, as some of those affected still have the possibility of successfully treating it in a conservative way within the first year of life.

In addition, physiotherapeutic exercises can help to maintain head mobility. From the first year of life and in those patients in whom physiotherapy has not shown sufficient effect, the torticollis is treated surgically. The shortened muscle is cut through at both ends with a small incision and the head is then fixed in place with a splint for about 8 weeks.

During this time, the cut surfaces grow together in an anatomically correct position. In addition to the already explained congenital muscular cause of a torticollis, there are numerous other causes, such as osseous, spastic, rheumatic or infectious torticollis. All further causes have in common that the neck and neck musculature, so also the Musculi sternocleidomastoidei (plural of Musculus sternocleidomastoideus) are indirectly affected.

Due to the constant head posture, the muscles of many affected persons are painfully hardened and tense. If the misalignment is not corrected, there is a risk that over time the muscles on the inclined side of the head will try to adapt to the changed position and shorten accordingly. This is one of the reasons why a torticollis should be treated with physiotherapy, especially if it has been going on for a long time.