Congenital Muscular Torticollis: Clinical Risk Factors and Rates of Surgery.

Background: Congenital muscular torticollis (CMT) is a rare shortening of the sternocleidomastoid muscle leading to lateral flexion and rotation of the cervical spine. Nonoperative treatment is most common; however, failure of contracture resolution may result in surgery. The aim of this study was to determine the clinical risk factors for CMT, exploring surgical correction rates, resolution rates, and cervical range of motion surrounding various treatment paths.

Methods: This retrospective study reviewed all patients diagnosed with CMT at a single institution from January 1, 2016, to July 31, 2023. Patient demographics, risk factors, and clinical notes were collected. Two analyses were performed, separated by sufficiency of the clinical note.

Results: A total of 171 patients were included in the final evaluation. Mean age was 5.0 ± 8.7 months at initial visit, 52% were female and 51.1% of patients had right-sided CMT. Of the 171 patients included in the initial analysis, 47.3% of patients had no other medical history prior to diagnosis of CMT, 12.3% had a history of developmental dysplasia of the hip (DDH), and 20.5% had plagiocephaly. Of all, 40.9% of patients were delivered via Cesarean section and 41.5% via normal spontaneous vaginal delivery. For the 110 patients included in treatment and range of motion (ROM) analysis, the mean follow-up time was 9.6 ± 13.0 months. Average lateral flexion improvement was 11.6 ± 20.4° (P < .0001). Average axial rotation improvement was 10.8 ± 23.1° (P < .0001). Eight patients underwent surgery; these patients' average length of physical therapy (PT) before surgery was 42.3 ± 14.3 months. By the last clinical visit, 87 patients had resolved CMT and 4 patients had resolving CMT.

Conclusions: Most infants with CMT who are healthy otherwise will improve rapidly and not undergo surgery. Meanwhile, for patients with longer treatment and/or surgical intervention, this study demonstrates favorable outcomes.

Key concepts: (1)History of developmental dysplasia of the hip and plagiocephaly were common in patients diagnosed with congenital muscular torticollis (CMT).(2)Rarely, infants with long treatment regimens for CMT will need surgical intervention, but, if indicated, the outcomes are favorable with no complications.(3)Overall, parents and caregivers can be reassured that most infants who have CMT are healthy children without significant risk factors that improve rapidly.

Level of evidence: III.