Persistent shortening of the sternocleidomastoid or, in other words, sternocleidomastoid muscle, provoked by birth trauma or underdevelopment, is congenital torticollis. This condition is characterized by a restriction in the cervical spine and a constant tilt of the head. In medical practice, pathology occurs quite often in infants. Most often it is registered in girls. The first mention of this disease was recorded in the second century.
General information
Underdevelopment of the sternocleidomastoid muscle, which is one of the large paired muscles, is the main cause of congenital torticollis in newborns. With its contraction, the face turns in one direction, and in the opposite direction, the head deviates. In the case when both muscles are contracted, the head is slightly pushed forward and thrown back. If the pathology is strongly pronounced, then the child has an asymmetry of the face andskulls. The reason for this phenomenon is that on the affected side, the shoulder, shoulder blade and collarbone are located higher, in contrast to the he althy one. At the same time, the diseased muscle is compacted, shortened and thickened, and there is swelling in its lower part. It is advisable to start treatment of congenital torticollis as early as possible, since only in this case the prognosis is favorable.
If a stable deformity has developed, then it will not be possible to eliminate it surgically. The only way surgery will help is to increase the ability to move the neck and head. At the rehabilitation stage, physiotherapy is of great importance.
Classification of pathological conditions
Depending on the origin, torticollis is distinguished:
- congenital - appears in utero or during unsuccessful birth;
- acquired - develops after delivery.
These two species are subdivided into the following forms:
- Muscular - with a congenital type, the baby has a short sternocleidomastoid muscle, and with an acquired one, overstrain of the neck muscles is the result of an injury or a chronic illness.
- Dermo-desmogenic - provokes a congenital appearance of deformity of the joints or folds in the neck. Acquired - chemical lesions of the dermis or burns, as well as an inflammatory process in the lymph nodes of the neck.
- Neurogenic. The congenital form manifests itself with an infectious infection of the fetus and subsequent muscular dystonia during the period of intrauterine formation. Acquired - occurs as a result of polio, cerebral palsy, tumors of the central nervous system.
- Arthrogenic. With congenital - there are areas of irregular shape or fusion of the vertebrae, and in the case of acquired - defects or fractures in the tissues of the vertebrae of the cervical region.
Distinguish the acquired type of torticollis:
- traumatic;
- reflex;
- installation;
- infectious;
- compensatory.
Congenital variants of pathology:
- myogenic;
- idiopathic;
- arthrogenic;
- osteogenic;
- neurogenic
Causes of congenital torticollis
Factors contributing to the occurrence of this pathology in newborns and babies up to a year:
- Abnormal position of the fetal head in the womb of the expectant mother. If the walls of the uterus squeezed it due to tight pressure, then there is a high risk of developing muscle deformity, which leads to torticollis in an unborn baby.
- Intrauterine inflammation of the muscle or chronic myositis. Both diseases can cause the sternocleidomastoid muscle to shorten, turning it into an inelastic tissue.
- Congenital anomalies. Hereditary formation of torticollis in practical medicine is quite rare.
- Injuries during delivery - use of vacuum, obstetric forceps. Excessive stretching or tearing breaks the elasticity of the muscle, and the remaining scar on the connective tissues interferes with flexibility and normal growth.
Clinical presentation in children
The main symptom of congenital torticollis in children is head tilt to the left orright shoulder, while the chin is turned in the opposite direction. Trying to put the head in the correct position causes a lot of crying. Other features include:
- decrease in hearing and vision on the side of the lesion;
- Teeth erupt late;
- clavicle and sternum deformity;
- concomitant congenital anomaly in the form of a cleft lip, cleft palate, malocclusion;
- Asymmetry of the facial skull - the ear, eyebrows and eyes are displaced on the affected side;
- delayed mental and physical development;
- during palpation of the neck, on the affected side, there is a dense and painful formation;
- failure of the heart and lungs;
- shoulder raised on affected side.
Change in the position of the head is not observed with bilateral lesions. However, any movement is limited and causes severe pain. In severe cases, which are, among other things, the result of a lack of treatment, there is a curvature of the thoracic, cervical and lumbar regions, deformation of the facial and brain regions of the skull. Such signs will be noticeable after the age of three.
Symptoms of torticollis
Clinic for various forms of pathology:
- Myogenic - most common. The baby's head is tilted towards the affected muscle and turned in the opposite direction. When palpating, a local rounded shape or uniform compaction is felt. Lack of treatment leads to abnormal development of the skull, as well as the area of the shoulder girdle andspinal disfigurement. The bones on the affected side become flat, the eye, eyebrow and ear drop, i.e. the face looks asymmetrical. In rare cases, bilateral myogenic torticollis is diagnosed. At the same time, movements are sharply limited, and the head is tilted towards the thoracic region.
- Neurogenic - the tone in the affected half of the body and limbs increases: the handle is compressed and bent, the torso is twisted, the leg is bent. In the other half of the body, the tone decreases. Passive and active movements in the neck area are preserved. At rest, the baby's head "leaves" in a vicious position.
- Idiopathic congenital torticollis - non-fixed and slight tilt of the head. On palpation examination, the sternocleidomastoid muscle is of normal shape and length, but very tense. Accompanying this form of the disease is encephalopathy, perinatal and segmental insufficiency of the cervical spine.
- Arthrogenic - rotational subluxation of the first cervical vertebra.
- Osteogenic - the neck is deformed (changed) and shortened, its mobility is limited, the head is pulled into the shoulders and turned to the side. This condition is accompanied by various anomalies in the development of the skeleton. This form of the disease provokes cervical sciatica.
Required diagnostic measures
Diagnosis of congenital torticollis includes the collection of anamnesis, medical examination data and the results of laboratory and instrumental studies. In addition, the doctor finds out which were:
- problems during the gestation period;
- birth pathological or normal.
If you suspecttorticollis, the baby is examined by a neurologist, orthopedist, otolaryngologist and ophthalmologist. Medical professionals rate:
- reaction of the body (reflexes);
- physical and mental development;
- muscle tone (muscle tension);
- neck mobility;
- disorders of the skeletal system, including the facial skeleton.
In addition, possible causes of the development of the disease are identified. Of the instrumental methods use:
- electromyography and electroneurography;
- Ultrasound of the head, neck and cerebral vessels;
- X-ray of the cervical spine;
- MRI and CT of the neck.
The doctor determines the list of examinations individually, depending on the nature of the pathology.
Treatment of pathology depending on the identified type of torticollis
Therapy is carried out immediately after diagnosis. It is very important for congenital torticollis in newborns to give the baby the correct position, using special devices, to stimulate head turns in different directions.
Depending on the type of torticollis, the following treatment is indicated:
- Neurogenic - local and general massage, as well as medication, aimed at reducing nervous excitability and muscle tone.
- Dermo-desmogenic - excision of scars and subsequent skin grafting.
- Osteoarticular congenital - staged corrective immobilization is done using head holders, thoracocranial bandage, Shants collar. If it is not possible to reduce the subluxation, then cervical fusion is performed.
- Muscular - massage courses, paraffin baths, UHF, exercise therapy, swimming, electrophoresis. Use of a cervical orthosis, Shants collar-tire. If there is no result from conservative methods, correction by surgical intervention is indicated.
Therapy Methods
Congenital torticollis is treated both conservatively and surgically. Often enough pharmaco- and physiotherapy for complete recovery and improvement of the condition. In severe cases, doctors advise surgery, which is acceptable for children over the age of one and a half years.
To treat torticollis in children, the following activities are carried out:
- Float in the tub with a neck ring.
- Using a neck brace, Shants collar.
- Physiotherapeutic procedures - paraffin, UHF or electrophoresis. Their goal is to improve blood circulation in the neck muscles, normalize tone, and dissolve scars.
- Sleep on an orthopedic pillow to unload the neck muscles.
- General and local (in the neck-collar zone) massage. With congenital torticollis, it is considered the most effective method of treatment. Thanks to this manipulation, blood flow improves, the tone of the affected and he althy muscles normalizes.
- Neck traction using a Glisson loop.
- Physical exercises, selected individually. They are aimed at lengthening and relaxing the sternocleidomastoid muscle.
- Regular head rotation control,proper wearing of the crumbs.
Massage services
Massage for congenital muscular torticollis is recognized as the most effective method by which this problem is corrected. The procedure is performed both on the he althy and on the affected side. In addition, the facial and trapezius dorsal muscles are developed. On the he althy side, movements are carried out with fingertips of varying intensity, including:
- thumping that promotes slight vibration;
- rubbing;
- stroking;
- kneading.
Through such actions, the stretched muscles are strengthened. On the part of the deformed muscle, it is forbidden to use tonic movements used in massage, only light stroking is allowed. The procedure for performing the massage is as follows. Initially, the muscles of the neck and face are developed from the he althy side. Further, they slowly move on to massaging the neck and a flat wide (trapezius) muscle, while the head is tilted to the affected side. On the deformed side, the movements should be light, the touches soft and imperceptible.
Therapeutic exercise
In addition to massage, with diagnosed congenital muscular torticollis in children, therapeutic exercises have also proven themselves well. Consider the exercises that doctors allow to do at home:
- The baby lies on the back, put a pillow under the head, fix the shoulders. Take your head with warm hands and very slowly with elements of lightvibration, shake in different directions.
- Turn over on a he althy side, put a hand under the head, lift the torso. Perform five to ten times a day.
- Put the baby on the tummy, raise your arms up and take them to the sides, bend and press to the sides.
These simple exercises lengthen the muscle fibers, reduce the risk of possible deformation not only of the muscles, but also of the bone tissues of the back, neck, and head. Therapeutic gymnastics will help to consolidate the result achieved after massage procedures.
Congenital torticollis: rehabilitation, risk group, consequences
After birth, in the first weeks, it is very difficult to diagnose this pathology. Therefore, young mothers should carefully monitor the crumbs older than three weeks old and older. This is especially true for children who had a breech presentation during childbirth, as they are at risk.
In the fifth or sixth month, when there is an active formation of muscles, this pathology can be clearly seen. The prognosis is favorable with its early detection. Rehabilitation includes a set of measures that the doctor selects individually. Usually it includes - position treatment, gymnastics, electrophoresis, massage, magnetotherapy. The duration of treatment for signs of congenital muscular torticollis is about a year.
The lack of timely measures taken by about three to six years leads to the appearance of secondary signs. The skeleton and muscles of the baby adapt to the wrong position, which contributes to the deformation of the body. Asymmetry appears on the face, the spine is affected(scoliosis develops). Correcting torticollis in babies after a year in a conservative way is quite difficult. Surgery is often required, after which rehabilitation is indicated in the resorts of Crimea, Anapa or Pyatigorsk.
