Robert N . Hensinger Eric T . Jones Developmental Ort hopaedics . 11 : The Spine , Trauma and Infection

Torticollis Torticollis, or wryneck, is a common clinical sign in a wide variety of childhood illnesses. When recognized at or soon after birth, the usual cause is congenital m u s c u l a r t o r t i c o l l i s . H o w e v e r , roentgenograms of the cervical spine should be obtained to exclude other less common congenital conditions, such as the fixed or bony torticollis associated with Klippel-Feil syndrome and/or anomalies of the atlanto-axial articulation (Table I). Congenital muscular torticollis is usually discovered in the first six to eight weeks of life. If the infant is examined within the first month of life, commonly a mass or 'tumor' is palpable in the neck' (Fig. 1). Generally there is a non-tender, soft enlargement which is mobile beneath the skin and attached to or located within the body of the sternocleidomastoid muscle. The mass obtains maximum size within the first month and then gradually regresses. If the child is examined at about four to six months of age the tumor usually will have disappeared and the only clinical findings are the contracture of the sternocleidomastoid muscle and torticollis posture-head titled towards the involved side and chin rotated towards the opposite shoulder2* (Fig. 2) . Congenital muscular torticollis is believed to result from local trauma to the soft tissues of the neck during delivery. Bi r th records of these chi ldren demonstrate a preponderance of breech or difficult forceps deliveries, or primiparous births', '. A common misconception is that the neck is contused during delivery and the resultant hematoma leads to fibrosis and contracture. However, experimental