1. Crooked neck

Definition

• Torticolis is a vicious attitude of the head and neck, typically presenting with abnormal slope and rotation!
• Characterized by permanent lateral bending of the head towards one of the shoulders, the head and the neck are tilted to one side and facial asymmetry develops

Etiology

• There are several causes:
• Most consider that torticollis forms as a result of cicatricial process in hematoma that has developed as a consequence of rupture of the SCM muscle
• Mechanical theory- fetal malposition during intrauterine development results in shortening of muscle
• Dysplasia theory- muscular dysplasia during embryogenesis.
• Ischemic theory- fibrotic and cicatricial processes develop due to ischemia
• Inflammatory theory- intrauterine or early postpartal inflammatory process of bacterial origin.
• Hereditary theory- genetic development defect which is inheritable

Types

• Congenital:
• Muscular
• Osseo-articular
• Neurogenic
• Acquired:
• Cutaneo-cicatricial form
• Acquired muscular torticollis
• Neurogenic acquired torticollis
• Habitual torticollis
• Osseo-articulational torticollis

Symptoms

• Most evident at the age of 3 to 5 years
• A spindle-like thickened tumefaction in the middle or the lower part of the SCM is found
• Solid on palpation!
• The oblique position of the muscle pulls and rotates the neck and the face towards the healthy side.
• The mobility of the neck is restricted, but there is no pain!
• In cases of spasmodic torticollis, the pain is unilateral and can radiate to the shoulder, and there is muscle stiffness