Torticollis is a pathological change of the musculoskeletal system in the neck, leading to an incorrect head setting in newborn or older children. With a crooked head, the head is deflected to the side and can be turned to the side.
Due to the deformation of the neck as a result of the growth and development of the child, defects in the skeleton and posture are formed, the symmetrical growth of the head is disturbed. Krivosheya is one of the common pathologies, more common in girls, can be considered as a variant of malformations.
The frequency of the crooked neck is the third among congenital diseases of the musculoskeletal system after congenital clubfoot and congenital dislocation of the hip.
The most commonly observed muscle form.
There are two large types of torticollis:
- congenital, with her baby is born initially,
- acquired, arises from violations in the skeleton or muscle tone.
Depending on the anatomical landmarks and tissues affected by torticollis, the following is released:
- dermatogenic (skin) form – the lesion concerns the skin and subcutaneous tissue,
- desmogenic – occurs as a result of inflammation processes in the neck (cellulitis, abscesses, lymphadenitis ),
- myogenic – occurs as a result of muscle damage,
- neurogenic torticollis is a lesion of the receptor neuromuscular apparatus with impaired muscle tone, more often with its increase, although there may be hypotension,
- arthrogenic form – develops with damage to the joints in the region of the cervical spine,
- osteogenic torticollis – damage to the bone and cartilage apparatus, the formation of additional processes of the cervical vertebrae, false cervical ribs, etc.
During the formation of torticollis, the main damage is experienced by a special muscle – sternocleidomastoid, it participates in the nodding processes of the head, when turning, bending.
In the case of congenital muscular crankshae, an underdevelopment is formed intrauterinely and, consequently, a shortening of the neck.
Also, torticollis can develop due to improper and prolonged installation of the head during intrauterine development, when not enough load is applied to the muscle.
In the process of labor, torticollis can form due to damage to the muscle by gross manipulations — squeezing the head, vacuum extraction, labor in the pelvic presentation with incorrect hatching and drooping of the head. In addition, such factors as a birth injury of a muscle with its tear, rupture, hemorrhage, ischemia, and stretching can lead to distortion. As a result, an inflammatory process is formed.
After giving birth, the cause can be lying on one side all the time, in an uncomfortable bed.
The first manifestations of torticollis muscle does not occur immediately after birth, but after 2-3 weeks, but they are often insignificant and can only be detected by experienced parents or an orthopedic surgeon.
At the age of about 3 weeks in the cervical area there is a thickening and significant muscle tightening (in the middle or lower third of the muscle, on the one hand).
Gradually, manifestations of torticollis will increase, while probing the muscles, the child may pucker or act up, attempts to turn the head in the opposite direction may cause crying and the inability to carry out the action.
In case of severe injuries, a deviation of the head to the side of the lesion occurs with the face turning towards the healthy muscle, the head is fixed in such a pathological position.
Without adequate therapy, the muscle thickens and shortens, gradually atrophies. Defects of the skull are formed with its smoothing on the affected side, asymmetry of the skull and pathological position of the head. In severe lesions, the shoulder on the affected side can be raised, the eyes on the affected side can be changed, and deformations of the facial and brain parts of the skull are expressed.
From the side of the back is formed cervical scoliosis, asymmetry of the skull in the ear and neck, muscle deformity.
The basis of the diagnosis is a thorough examination of the child by an orthopedic doctor and a visual assessment of the head position, probing the muscle and comparing it with the healthy side, setting the head to the required position.
For the purpose of additional diagnostics, radiography of the cervical spine is performed, sometimes MRI of the cervical spine will be used.
Muscular torticollis in newborns can be treated in a conservative way, since all tissues and muscles are still malleable, and you can stretch and develop a muscle. In case of severe lesions leading to a pronounced defect, operational repair methods may be required.
Conservative therapy includes:
- carrying out special laying on the side for stretching the muscles due to the position,
- conducting special massages to enhance the tone, enhance blood circulation and relieve inflammation,
- the use of special orthopedic designs, trench collars,
- lamp sollux or heating pad, electrophoresis,
- The special position of the child to sleep with rolled and planted under the back with towels and rollers.
On average, torticollis is eliminated in 5-6 months, gradually the muscle is stretched and compared with the healthy one.
Surgical treatment is indicated for children after 2 years of age, with severe dermatogenous and muscular defects. Artificial lengthening of the muscle is carried out with further imposition of special structures and physical therapy, massage and gymnastics to develop and stretch the muscles, raise the tone.
On average, rehabilitation after surgery takes 2 months or more.
The prognosis for timely treatment is favorable, torticollis disappears without a trace. Without treatment, persistent deformities and asymmetry of the skull, shortening and degeneration of the muscle, impaired support function of the spine and disability occur.