Torticollis (Wry Neck): SCM Contracture, Types & Stretching MCQs

Torticollis (Wry Neck)

Torticollis (Twisted Neck) is a deformity characterized by lateral flexion of the head to one side and rotation to the opposite side. The most common pediatric cause is Congenital Muscular Torticollis (CMT).

1. Types

• Congenital Muscular Torticollis (CMT): Fibrosis/contracture of the Sternocleidomastoid (SCM) muscle. Often due to birth trauma or intrauterine positioning.
• Acquired Torticollis: Due to spasm (sleeping wrong), infection (Grisel's syndrome), or trauma (C1-C2 rotatory subluxation).

2. Clinical Features of CMT

• Posture: Head tilted to the affected side, chin rotated to the opposite side ("Cock Robin" position).
• SCM Tumor: A palpable olive-sized lump in the SCM muscle (appears at 2-3 weeks, disappears by 6 months).
• Plagiocephaly: Flattening of the face/skull on the affected side due to positioning.

3. Management

• Physiotherapy (First line): Gentle passive stretching (Side bend away, Rotate towards) and positioning. 90% cure rate if started early.
• Surgery: Bipolar release of SCM (if resistant after 1 year or severe restriction).

25 Practice MCQs

Q1. The primary muscle involved in Congenital Muscular Torticollis is:

Answer: A). It becomes fibrotic and shortened.

Q2. The typical deformity is:

Answer: A). Following the action of the SCM.

Q3. Grisel's Syndrome is:

Answer: A). Inflammation causes ligament laxity at C1-C2.

Q4. The "SCM Tumor" usually appears at:

Answer: A). It is not a neoplasm but fibromatosis.

Q5. Plagiocephaly refers to:

Answer: A). Secondary to lying on one side constantly.

Q6. To stretch a Right SCM torticollis, you should:

Answer: A). Reverse the deformity.

Q7. Klippel-Feil Syndrome involves:

Answer: A). Bony cause of torticollis.

Q8. Spasmodic Torticollis (Cervical Dystonia) is:

Answer: A). Treated with Botox.

Q9. Surgery for CMT is indicated if:

Answer: A). 90% resolve with stretching.

Q10. Ocular Torticollis is caused by:

Answer: A). Neck ROM is full when one eye is covered.

Q11. Breech presentation is a risk factor for CMT. True/False?

Answer: A). Intrauterine crowding.

Q12. Bipolar release involves releasing SCM at:

Answer: A). For severe cases.

Q13. Facial Hemihypoplasia (smaller face) occurs on which side?

Answer: A). Due to vascular compression or molding.

Q14. Positioning therapy involves:

Answer: A). Encourage active correction.

Q15. Acute Wry Neck in young adults is often due to:

Answer: A). "Slept funny". Resolves in days.

Q16. Is X-ray necessary in congenital torticollis?

Answer: A). Don't miss a bony block.

Q17. The SCM is innervated by:

Answer: A). Risk during surgery.

Q18. Helmet therapy (Cranial Orthosis) is used for:

Answer: A). Remolds the skull shape.

Q19. Sandifer Syndrome is torticollis associated with:

Answer: A). Posturing to relieve reflux.

Q20. The "Cock Robin" position refers to:

Answer: A). Classic description.

Q21. Is the SCM tumor painful?

Answer: B). Unless passively stretched aggressively.

Q22. TOT Collar is:

Answer: A). Used in older infants to encourage midline head posture.

Q23. Associated DDH (Hip Dysplasia) occurs in:

Answer: A). "Packaging disorders".

Q24. Retropharyngeal abscess can cause torticollis by:

Answer: A). Always check throat in acquired cases with fever.

Q25. Stretching should be performed:

Answer: A). Consistency is key.