Congenital Muscular Torticollis

Prepared and reviewed by the PrepElephant Academic Review Team

First published 14 Oct 2026 · Spot an error?

Reference basis: Maheshwari's Essential Orthopaedics; Apley's System of Orthopaedics and Fractures

On this page

Direct answer
What you must remember
Separating congenital from acquired torticollis
Where the exam tries to catch you
Frequently asked questions
Related topics

Direct answer

Congenital muscular torticollis is a fixed lateral neck tilt with contralateral rotation, caused by fibrosis or shortening of one sternocleidomastoid muscle in infancy. It usually presents in the first months of life as a firm swelling in the muscle or as a head posture that does not resolve. Structured passive stretching and physiotherapy succeed in most infants, and surgical release is reserved for those who fail therapy.

What you must remember

Posture: the head tilts towards the affected side while the chin rotates to the opposite side, the classic pattern.
Sternomastoid tumour: a firm, spindle-shaped swelling in the muscle in the early weeks; it often regresses and is a common antecedent of the tilt.
Hip link: congenital torticollis is associated with developmental dysplasia of the hip, so hip examination belongs to every assessment.
Asymmetry: untreated posture for months leads to plagiocephaly and facial asymmetry.
First line: passive stretching of the sternocleidomastoid, taught to parents and performed by physiotherapists, helps most infants within the first year.
Surgery: sternocleidomastoid release, usually a distal tenotomy or myotomy, is considered once stretching has failed, typically after the first year.
Acquired causes: atlantoaxial rotatory subluxation after infection, posterior fossa lesions, cervical anomalies and ocular causes such as superior oblique palsy must be excluded.

Separating congenital from acquired torticollis

A 9-year-old boy wakes with a painful, fixed neck tilt a day after a sore throat. The table separates this from an infant with a congenital tilt, where the history and examination differ.

Feature	Congenital muscular torticollis	Acquired torticollis
Onset	Early infancy, often noticed in the first weeks or months	Any age, often after an upper respiratory or ENT infection
Pain	Painless, with a fixed and stable posture	Often painful, with guarding and a sudden change in posture
Key structure	Shortened or fibrotic sternocleidomastoid, sometimes with a palpable mass	Usually normal muscle; atlantoaxial subluxation, posterior fossa lesion or ocular cause
Associated signs	Developmental dysplasia of the hip and plagiocephaly	Neurological signs, or a squint and ocular misalignment
First step	Structured stretching and physiotherapy	Urgent imaging and specialist review to exclude the cause

Acquired torticollis cannot wait, because its cause may threaten the cervical spine or the brain. Congenital torticollis is usually managed by stretching, with release reserved for failure.

Where the exam tries to catch you

Examiners test whether you can recognise the dangerous acquired cause and remember the hip.

Trap: calling every infant tilt congenital torticollis without checking the eyes and neck. Correct: ocular causes and cervical pathology must be excluded, and sudden painful torticollis after infection should prompt atlantoaxial evaluation.
Trap: operating early for a mass that is still resolving. Correct: the sternomastoid swelling often regresses, so stretching is tried for a period before release is considered.
Trap: forgetting the hip. Correct: developmental dysplasia of the hip coexists with congenital torticollis, so both hips are examined in every infant with the condition.

Frequently asked questions

What is the typical posture in congenital muscular torticollis?

The head tilts towards the shortened sternocleidomastoid while the chin rotates to the opposite side. The posture is fixed, and passive stretching reduces the deformity in most infants.

Why must the hips be examined in congenital muscular torticollis?

Congenital muscular torticollis is associated with developmental dysplasia of the hip, so every infant with the condition needs a hip assessment. A missed dysplastic hip carries a risk of lasting disability.

What is Grisel syndrome?

Grisel syndrome is atlantoaxial rotatory subluxation following an upper respiratory or ENT infection, producing a painful, fixed torticollis. It is an important acquired cause of torticollis and needs prompt imaging and specialist review.

When is surgical release indicated in congenital muscular torticollis?

Surgical release is considered when stretching and physiotherapy fail to correct the posture, usually after the first year of life. The procedure is typically a distal sternocleidomastoid release, chosen to restore neck range of motion.