Conditions · Spine

Torticollis !

Torticollis is a twisted neck: the head tilts to one side while the chin turns to the other; in babies it is often a tight neck muscle.

Updated 2026-10-29

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In embryology

What it is

Abnormal twisted posture of the head and neck: the head tilts to one side while the chin turns to the other. It can be congenital, usually from a tight sternocleidomastoid muscle, or acquired.

Who gets it

Congenital muscular torticollis is one of the most common musculoskeletal conditions of newborns. Acute acquired torticollis (wry neck) is very common in children and adults.

Causes

Congenital muscular torticollis: fibrosis and shortening of the sternocleidomastoid
Acute wry neck from muscle spasm or a minor facet joint problem
Atlantoaxial rotatory subluxation, including Grisel syndrome after throat or ear infection or surgery
Infection: retropharyngeal abscess, cervical lymphadenitis
Drug-induced acute dystonia (antipsychotics, some antiemetics) and cervical dystonia
Trauma, eye problems (fourth nerve palsy), vertebral anomalies and posterior fossa tumours

Risk factors

Breech position, difficult delivery or first pregnancy (congenital form)
Recent upper respiratory or throat infection (Grisel syndrome)
Recent use of dopamine-blocking drugs
Down syndrome and other conditions with ligament laxity (atlantoaxial instability)

Pathophysiology

In the congenital form, the sternocleidomastoid becomes fibrotic and short, perhaps from crowding in the womb or birth trauma. The tight muscle tilts the head toward its side and turns the chin away. In acquired forms, muscle spasm, rotatory displacement of C1 on C2, inflammation or abnormal brain signals hold the head in the same posture.

Classification

Congenital: muscular (sternocleidomastoid), postural, or bony (vertebral anomalies)
Acquired: traumatic, infectious or inflammatory, neurological (dystonia, tumour), ocular
Cervical dystonia (spasmodic torticollis) in adults

Symptoms and signs

Head tilted toward one side with the chin turned to the other
Limited neck rotation and side bending
In infants: a firm lump in the sternocleidomastoid in the first weeks and flattening of the skull (plagiocephaly)
In acute wry neck: sudden painful neck stiffness, often on waking
In cervical dystonia: involuntary twisting, tremor and pain

Diagnosis

Clinical: Age, onset, drug history and exam of the neck muscles, range of motion, eyes and neurology. In infants, check the hips for dysplasia.
Tests: Blood count and inflammatory markers when infection is suspected.
Imaging: Ultrasound of the sternocleidomastoid in infants; neck X-rays for vertebral anomalies; dynamic CT for atlantoaxial rotatory subluxation; CT or MRI for abscess, tumour or trauma.

Differential diagnosis

Atlantoaxial rotatory subluxation
Retropharyngeal abscess
Posterior fossa tumour
Ocular torticollis (fourth nerve palsy)
Cervical spine fracture or congenital vertebral anomaly
Benign paroxysmal torticollis of infancy

Goal of treatment

Find and treat the cause, restore full neck movement and head position, and prevent skull and facial asymmetry in infants.

Treatment

Rehabilitation: Infants: early stretching of the sternocleidomastoid and positioning by physiotherapists and caregivers; most improve within months.
Conservative: Acute wry neck: heat, gentle movement and reassurance; treatment of the cause in infection or rotatory subluxation (sometimes traction and a collar).
Medical: Analgesics and muscle relaxants for acute wry neck; anticholinergic or antihistamine drugs for drug-induced dystonia; botulinum toxin injections for cervical dystonia.
Surgical: Surgical release or lengthening of the sternocleidomastoid for congenital torticollis that persists despite therapy; fusion for chronic irreducible atlantoaxial subluxation.

Complications

Plagiocephaly and facial asymmetry in infants
Permanent limitation of neck movement
Neurological injury from untreated subluxation or infection

Prognosis

Congenital muscular torticollis treated early with stretching has an excellent outcome, and few need surgery. Acute wry neck resolves within days to a couple of weeks. Outcome of other forms depends on the cause.

Test yourself

Think of the answer, then tap the question to see it.

In congenital muscular torticollis, which way do the head and chin point?

The head tilts toward the affected sternocleidomastoid and the chin turns to the opposite side.

Which hip condition should be screened for in an infant with congenital muscular torticollis?

Developmental dysplasia of the hip, which is associated with it.

What is the first-line treatment for congenital muscular torticollis?

Early stretching and positioning with physiotherapy; surgery is reserved for persistent cases.

What is Grisel syndrome?

Non-traumatic atlantoaxial rotatory subluxation after a throat or ear infection or surgery, causing torticollis.

Which drug classes can cause acute dystonic torticollis?

Dopamine-blocking drugs such as antipsychotics and some antiemetics; it responds to anticholinergic or antihistamine drugs.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Congenital Torticollis (StatPearls (NCBI Bookshelf), 2024).

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Representative model, for educational purposes only.

Sternocleidomastoid highlighted on the Durgical 3D model