CONGENITAL MUSCULAR TORTICOLLIS (CMT): SYMPTOMS, CAUSES, TREATMENT AND MORE
Medically Reviewed by Dr. Sony Sherpa (MBBS)
Congenital Muscular Torticollis (CMT) is a condition that affects many newborns and young children. It is characterized by a noticeable head tilt, often to one side. Other names for the condition include twisted neck or wry neck.[1]
Early identification and intervention are crucial for preventing long-term complications.
This blog will explore CMT's causes, symptoms, and treatment options and discuss the challenges and strategies for living with this condition.
What is Congenital Muscular Torticollis?
Congenital Muscular Torticollis, often abbreviated as CMT, is a postural deformity. It is typically evident at birth or shortly after.
The primary characteristic of CMT is a noticeable tilt of the head. This tilt is often to one side due to the shortening or excessive contraction of the sternocleidomastoid muscle, which runs along the side of the neck from the base of the skull to the collarbone.
These muscles enable contralateral neck rotation, inclining on the same side, and the bending of the head. The motor function leads to the head and neck tilting towards the side where the muscle is impacted and rotating to the reverse side.[2]
CMT is a relatively common condition. It affects approximately 1 in 250 to 300 live births. This condition affects boys and girls equally. It may also develop later in life in adults as acquired torticollis.
Muscular torticollis is an intermediate form of one of three types of torticollis. The mildest form of CMT is postural torticollis, with SCM torticollis being the most severe. In SCM torticollis, muscular fibrosis (scarring and inflammation) is evident.[3]
Congenital Muscular Torticollis Symptoms
Congenital Muscular Torticollis is often noticeable at birth or shortly after, at 2-3 weeks of age. The most common symptom is a noticeable tilt of the baby's head to one side.
The symptoms of CMT can vary in severity. Some children may have a mild head tilt, while others may have significant neck stiffness and limited mobility.
In addition to the head tilt, the baby may have difficulty turning their head to the opposite side. This is due to the shortening or tightening of the sternocleidomastoid muscle, which restricts neck movement.
Other key features of CMT include:
- Limited neck mobility
- Facial asymmetry
- Difficulty with neck movement
- A soft lump on the one side of the neck (often disappears within a few months)
- Pain, tremors, and neck stiffness (especially in acquired torticollis)
Facial asymmetry is another symptom of CMT. This can occur as the condition progresses and the baby consistently holds their head in one position. Over time, this can lead to changes in the shape of the skull, a condition known as plagiocephaly.
Prompt diagnosis allows for early intervention, preventing long-term effects and complications. These complications can include permanent muscle shortening and skeletal deformities, affecting a child's physical appearance, development, and mobility. Other complications include poor feeding, lower balance, plagiocephaly (flattened head), and hearing or vision problems.[4]
If you notice any of these signs in your baby, it is essential to seek medical advice promptly.
Causes and Risk Factors of CMT
It is unclear what exactly causes congenital muscular torticollis.
There are several factors known to contribute to the development of this condition.
One potential cause is abnormal baby positioning in the womb or a tighter-than-usual womb. This can put pressure on the baby's neck, leading to muscle damage and the development of CMT. Some infants develop hip dysplasia with CMT for the same reasons. Lower levels of amniotic fluid, as seen in twin transfusion syndrome, may also contribute to CMT development.[5]
Birth trauma is another possible cause. During a difficult delivery, the baby's sternocleidomastoid muscle may be injured, leading to fibrosis or scarring of the muscle. This can result in the characteristic head tilt of CMT.
Genetic factors may also play a role in the development of CMT. Some studies suggest that CMT may run in families, indicating a possible genetic predisposition.
Key risk factors for CMT include:
- Difficult or traumatic birth
- Multiple pregnancies (twins, triplets, etc.)
- Breech position in the womb
- Family history of CMT
It is important to note that having one or more of these risk factors does not indicate that a child will develop CMT for certain. However, understanding these risk factors can help in early detection and intervention.
Diagnosis of CMT
Early diagnosis of Congenital Muscular Torticollis is crucial for effective treatment. The sooner the condition is identified, the better the chances of successful management.
Diagnosis typically comprises a physical examination and may include imaging scans such as ultrasound or MRI[6]. These tests can assist with confirming the diagnosis and assess the severity of the condition to verify which type of torticollis.
Imaging can also ascertain if the infant has hip dysplasia or not and may rule out other conditions, such as cervical dystonia.
Treatment Options for CMT
Treatment for Congenital Muscular Torticollis is typically non-surgical.
The primary treatment is physical therapy, which focuses on stretching and strengthening exercises to improve the condition of the affected neck muscle. If there is a mass, treatment must begin at 2 months or sooner to prevent complications. Most infants recover fully by 6-12 months with treatment.
Bracing may be required to support proper neck alignment in more severe cases when conservative treatment does not provide enough relief. If bracing fails, surgery may be considered. This option is typically a last resort reserved for treating severe cases.
Physical Therapy Management Of CMT
The cornerstone of CMT treatment is physical therapy. It involves a series of stretching and strengthening exercises designed to improve neck mobility and correct the head tilt.[7]
The role of parents and caregivers in performing prescribed home exercises for their children is crucial. Regular and consistent therapy can significantly improve the condition.
The therapy regimen is personalized in line with the condition’s severity and the child's response to therapy. Regular reassessment is necessary to ensure that treatment goals are being met and to make necessary adjustments.
Bracing and Other Non-Surgical Interventions
Besides physical therapy, other non-surgical interventions can assist with managing CMT. One such intervention is bracing.
Bracing involves using a device to support the neck and promote proper alignment. It is typically used in more severe cases or when physical therapy alone is insufficient.
While bracing can be effective, it is essential to note that it is not a substitute for physical therapy. It is usually used in conjunction with physical therapy and other treatments.
Congenital Muscular Torticollis Surgery
Usually, surgery is considered the last option to treat CMT, reserved for severe or refractory (treatment-resistant) cases.
The surgery involves lengthening the shortened sternocleidomastoid muscle. This can help with head tilt correction and improved neck mobility.
While surgery may effectively treat the condition, it is not without risks. Therefore, discussing all treatment options with your healthcare provider before deciding is essential.
Living with CMT: Daily Life and Long-Term Management
Living with Congenital Muscular Torticollis can be challenging. However, with the right treatment and support, individuals with CMT can lead fulfilling lives.
Adherence to therapy regimens is crucial for optimal outcomes. This includes regular physical therapy sessions and home exercises. Supporting a healthy lifestyle that includes proper nutrition and regular exercise is also essential.
Here are some helpful activities, tips, and advice for strengthening an infant's neck muscles[8]:
- Carry babies in your arms or a sling or carrier and regularly alternate head positions
- Avoid excessive use of car seats, swings, strollers, and bouncers
- Allow babies to move and play freely for improved neck mobility
- Encourage babies to look in different directions
- Reposition baby's head to the center if tilted in a car seat or stroller
- Allow for supervised daily tummy time sessions where the infant is on their tummy and attempting to lift up their neck, arms, and legs. This helps them to build the muscles necessary for optimal movement.
- Promote balanced development through play activities that engage both hands and legs
- Encourage reaching for toys with both hands to stimulate midline positioning of the body
- Keep baby's head centered while sitting on your lap
- Alternating feeding positions, i.e., changing the arm used to hold the infant during feeding; to encourage the baby to turn the head in different directions
- When putting the baby to bed, alternate the side to which the head is placed to enable the baby to move their neck in different directions for visual exploration
Support groups can provide practical educational resources and emotional support. Learning from the experiences of others facing similar challenges is often very beneficial.
Finally, regular follow-up care is essential. This allows for monitoring of progress and adjustment of treatment plans as needed.
Conclusion
Living with Congenital Muscular Torticollis can be challenging. However, with early diagnosis, appropriate treatment, and ongoing management, individuals with CMT can lead fulfilling lives.
It is important to remember that each person's journey with CMT is unique. Treatment plans should be personalized, considering the individual's needs, response to therapy, and lifestyle.
As we continue to learn more about CMT, advancements in research and treatment are expected. This gives hope for improved management strategies and better outcomes for those with this condition.
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