Persistent shortening of the sternocleidomastoid or, in other words, the sternocleidomastoid muscle, provoked by birth trauma or underdevelopment, is a congenital torticollis. This condition is characterized by a restriction in the cervical spine and a constant inclination of the head. In medical practice, pathology is quite common in infants. Most often, it is recorded in girls. The first mention of this ailment was recorded in the second century.
general information
Underdevelopment of the sternocleidomastoid muscle, which is one of the major paired muscles, is the main cause of congenital torticollis in newborns. With its contraction, the face turns in one, and in the opposite direction - the head deviates. When both muscles are contracted, the head is slightly advanced and throws back. If the pathology is very pronounced, then the child has an asymmetry of the face and skull. The reason for this phenomenon is that on the affected side, the shoulder, shoulder blade and clavicle are located higher, in contrast to the healthy one. In this case, the diseased muscle is compressed, shortened and thickened, and there is a swelling in its lower part. Treatment of congenital torticollis is advisable to begin as early as possible, since only in this case the prognosis is favorable.
If a stable deformation has developed, then it will not be possible to eliminate it surgically. The only thing that helps the operation is to increase the possibility of neck and head movements. At the rehabilitation stage, physiotherapeutic treatment is of great importance.
Classification of pathological conditions
Depending on the origin, they distinguish torticollis:
- congenital - appears in utero or with unsuccessful childbirth;
- acquired - develops after delivery.
These two types are divided into the following forms:
- Muscular - with the innate type, the baby has a short sternocleidomast, and with the acquired type, overstrain of the neck muscles is a consequence of trauma or a chronic ailment.
- Dermo-desmogenic - provokes a congenital appearance of the deformation of the joints or folds in the neck. Acquired - chemical lesions of the dermis or burns, as well as the inflammatory process in the lymphatic cervical nodes.
- Neurogenic. The congenital form is manifested in infectious infection of the fetus and subsequent muscular dystonia during the period of intrauterine formation. Acquired - occurs as a result of poliomyelitis, cerebral palsy, central nervous system tumors.
- 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 pathology options:
- myogenic;
- idiopathic;
- arthrogenic;
- osteogenic;
- neurogenic
Causes of congenital torticollis
Factors contributing to the occurrence of this pathology in newborns and infants up to a year:
- The abnormal position of the fetal head in the womb of the future mother. If the walls of the uterus squeezed it due to tight pressure, then there is a high risk of muscle deformation, which leads to a crank in an unborn baby.
- Intrauterine muscle inflammation or chronic myositis. Both diseases can provoke a shortening of the sternocleidomastoid muscle, turning it into inelastic tissue.
- Congenital malformations. The hereditary formation of torticollis in practical medicine is quite rare.
- Injuries during delivery - the use of vacuum, obstetric forceps. Excessive stretching or tearing violates the elasticity of the muscle, and the remaining scar on the connective tissues interferes with flexibility and normal growth.
The clinical picture in children
The main symptom of congenital torticollis in children is a tilt of the head to the left or right shoulder, while the chin unfolds in the opposite direction. Trying to give the head the correct position causes a strong cry. Other signs include:
- hearing loss and vision loss;
- teeth erupt late;
- deformation of the clavicle and sternum;
- concomitant congenital anomaly in the form of a cleft lip, cleft palate, malocclusion;
- asymmetry of the facial skull - ear, eyebrows and eyes are displaced on the affected side;
- retardation of mental and physical development;
- palpation examination of the neck, on the affected side, there is a dense and painful formation;
- malfunction of the heart and lungs;
- on the sore side, the shoulder is raised.
A change in the position of the head is not observed with bilateral damage. However, any movements are limited and cause severe pain. In severe cases, which are, inter alia, a consequence of the lack of treatment, there is a curvature of the thoracic, cervical, and lumbar spine, and deformation of the facial and brain parts of the skull. Such signs will be noticeable after three years of age.
Symptoms of torticollis
Clinic for various forms of pathology:
- Myogenic - occurs most often. 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 and spinal disfigurement. The bones on the affected side become flat, the eye, eyebrow and ear go down, i.e. the face looks asymmetrically. In rare cases, bilateral myogenic torticollis is diagnosed. At the same time, the movements are sharply limited, and the head is inclined towards the thoracic region.
- Neurogenic - the tone in the affected half of the body and limbs increases: the handle is compressed and bent, the body is curved, the leg is bent. In the other half of the body, tone decreases. Passive and active movements in the neck area are preserved. At rest, the baby’s head "goes" into a vicious position.
- Idiopathic congenital torticollis is an unfixed and slight tilt of the head. On palpation examination, the sternocleidomulus is normal in shape and length, but is very tense. This form of the disease is accompanied by 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 of the development of the skeleton. This form of the disease provokes cervical radiculitis.
Necessary diagnostic measures
Diagnosis of congenital torticollis includes the collection of medical history, data from a medical examination and the results of laboratory and instrumental studies. In addition, the doctor finds out what were:
- problems during the period of bearing a baby;
- births are pathological or normal.
If you suspect a torticollis, the baby is examined by a neurologist, orthopedist, otolaryngologist and optometrist. Medical professionals evaluate:
- body reaction (reflexes);
- physical and mental development;
- muscle tone (muscle tension);
- neck mobility;
- violations of the skeletal system, including the facial skeleton.
In addition, the possible causes of the development of the disease are identified. From instrumental methods use:
- electromyography and electroneurography;
- Ultrasound of the head, neck and blood vessels of the brain;
- 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. With congenital torticollis in newborns, it is very important 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-desmogenous - excision of scars and subsequent skin plastic.
- Skeletal-articular congenital - they make phased corrective immobilization using head holders, a thoracocranial bandage, and Shants collar. If it is not possible to correct the subluxation, then spinal fusion of the cervical spine is performed.
- Muscular - massage courses, paraffin baths, UHF, physiotherapy exercises, swimming, electrophoresis. The use of cervical orthosis, Shants collar-splint. If there is no result from conservative methods, correction by surgical intervention is indicated.
Therapies
Treatment of congenital torticollis is carried out both conservatively and surgically. Pharmacotherapy and physiotherapy are often enough to fully recover and improve. In severe cases, doctors advise surgical intervention, which is acceptable for children over the age of one and a half years.
For the treatment of torticollis in children, the following activities are carried out:
- Swimming in the bath with a cervical rubber ring.
- Using a cervical collar, a collar of Shants.
- Physiotherapeutic procedures - paraffin, UHF or electrophoresis. Their goal is to improve blood circulation in the cervical muscles, normalization of tone, as well as resorption of scars.
- Sleep on an orthopedic pillow to relieve neck muscles.
- General and local (in the cervical-collar zone) massage. With congenital crankshaft, it is considered the most effective treatment. Thanks to this manipulation, the blood flow improves, the tone of the affected and healthy muscles is normalized.
- Neck extension using Glisson loop.
- Physical exercises selected individually. They are aimed at lengthening and relaxing the sternocleidomastoid muscle.
- Regular control over the rotation of the head, proper wearing of crumbs.
Massage services
Massage with congenital muscle crank is recognized as the most effective method by which this problem is corrected. The procedure is performed both from a healthy and an affected side. In addition, facial and trapezius dorsal muscles are developed. On the healthy side, movements of the fingertips of various intensities are carried out, including:
- striking, which promotes easy vibration;
- trituration;
- stroking
- kneading.
Thanks to such actions, the stretched muscles are strengthened. From the side of the deformed muscle, it is forbidden to use the tonic movements used during massage, only light stroking is permissible. The procedure for performing the massage is as follows. Initially, the muscles of the neck and face are developed from the healthy side. Further, they slowly move on to massaging the neck and flat broad (trapezoid) muscle, while the head is tilted to the affected side. From the deformed side, movements should be light, touch soft and invisible.
Physiotherapy
In addition to massage, with diagnosed congenital muscle torticollis in children, therapeutic gymnastics is well established. Consider the exercises that doctors are allowed to carry out at home:
- The baby lies on the back, put a pillow under the head, and fix the shoulders. Warm hands to take the head and very slowly with elements of light vibration, swing in different directions.
- Flip over to a healthy side, put a palm under the head, raise the body. Perform five to ten times a day.
- Put the baby on the tummy, raise your hands up and take it to the sides, bend and press it to the sides.
These simple exercises lengthen muscle fibers, reduce the risk of possible deformation of not only muscles, but also bone tissue of the back, neck, and head. Therapeutic gymnastics will help 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 need to carefully monitor the crumbs older than three weeks of age and older. This is especially true for children who had a gluteal presentation at birth, since they are at risk.
In the fifth to sixth month, when active muscle formation occurs, this pathology can be clearly noticed. The prognosis is favorable with its early detection. Rehabilitation includes a set of measures that the doctor selects individually. Usually it includes - posture treatment, gymnastics, electrophoresis, massage, magnetotherapy. The duration of treatment for signs of congenital muscle torticollis is about a year.
The lack of timely measures taken by about three to six years leads to the appearance of secondary symptoms. 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. Often, surgical intervention is required, after which rehabilitation at the resorts of Crimea, Anapa or Pyatigorsk is indicated.