Torticollis

  • a combined head tilt & rotatory deformity
Torticollis, sternocleidomastoid
Sternocleidomastoid. Image by Image:Gray385.png modified by Uwe Gille, Wikimedia Commons, Public domain.

Clinical

  • pain
  • vertigo
  • CSF obstruction
  • Myelopathy
  • Torticollis

Aetiology

Osseous types

  • Basilar impression – 15% present with  torticollis
    • Primary
      • related to vertebral defects e.g. Klippel Feil, occipital-atlanto fusion
    • Secondary
    • nonoperative treatment of basilar impression is surgical via anterior decompression & fusion
  • Atlantooccipital
    • Occipital cervical synostosis
    • Basilar impression
    • Odontoid abnormality
  • Unilateral absence of C1
  • Familial Cervical Dysplasia
  • Atlantoaxial Rotatory Displacement – see above

Muscular

  • Congenital Muscular Torticollis
    • Most common type in infant or small child
    • Theory is “compartment syndrome” of the sternocleidomastoid
    • Leads to head tilt & chin rotation
    • Frequently associated with DDH
    • Facial deformity may occur as the child grows
    • Stretching may or may not work – not contraindicated
    • Surgery – variable approach with unipolar or bipolar release & lengthening
  • Neurologic Type
    • Secondary to CNS tumour, syrinx, Arnold Chiari malformation etc
    • Secondary to ophthalmologic problem & this being positional
  • Sandifer Syndrome
    • GER & abnormal posture of the neck usually torticollis
    • Usually infant with CP
    • Get upper GI studies

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.