Update: October 2018
Krivosheya in infants occurs quite often and
diagnosed in 1% of cases still in the hospital. The disease is characteristic
for younger children, but most often it develops
It is in the neonatal period, when the structure of the body is still
fragile and it is easily exposed to external factors.
Treatment данного состояния необходимо начинать как можно раньше,
from the time of diagnosis, because from the early start of therapy
positive results depend. Despite the ugliness
diagnosis and horror of parents, torticollis of newborns lends itself well
treatment, the main thing is to have patience and perseverance to comply
The term “torticollis” and the classification of the disease
Krivosheya is included in a series of orthopedic diseases. This
the condition is characterized by a deformation of the neck that manifests itself
typical symptoms: wrong position of the head when the head
the baby has a slope in the affected side and is partially turned face
towards healthy sternocleidomastoid muscle
(located on both sides of the neck).
Depending on the origin of the disease can be:
- congenital (the disorder occurred during the intrauterine
development or at difficult childbirth);
- acquired (disease formed after childbirth).
Depending on the etiological factors emit:
- muscle torticollis (GCS-muscle defect);
- compensatory torticollis (as a result of ophthalmic
diseases or hearing impairment);
- neurogenic torticollis (as a result of a brain injury,
spinal cord or peripheral nervous system);
- bone torticollis (abnormalities in the structure of the spine);
- reflex torticollis (due to involuntary contractions
- arthrogenic torticollis (problems with vertebral joints,
- dermatogenous torticollis (cicatricial tightening of the skin);
- hypoplastic torticollis (underdevelopment of GCS-muscles).
Statistical data on newborn babies:
- boys get sick more often (some sources indicate that
- predominantly right-sided neck lesion;
- among newborns this disease is more often diagnosed in
children born in breech presentation (even with cesarean
What develops torticollis
Depending on the origin, causes of torticollis are different.
Congenital abnormalities are noted more often than acquired and
due to the deformation of the child’s head and its skeleton by shortening
GCS muscles or changes in the trapezius muscle of the back.
Causes of Congenital Disease
Incorrect head setting in labor
For example, with asynclitism in labor, the uterine walls are excessively
squeeze the fruit on the one hand, which contributes to long
intervals of convergence of the GCS-muscles at the points of attachment.
Shortening of GKS muscles
Congenital sperm hypoplasia (GCS) muscle provokes it
fibrotic rebirth, so that muscle is losing
Intrauterine GCS inflammation
Acute myositis in utero goes further in chronic
the shape and muscle tissue is replaced by fibrous (with intrauterine
GX rupture muscles in labor
The similar phenomenon is noted at the complicated childbirth, long
period, the imposition of obstetric forceps and during childbirth in
breech previa. At the point of rupture a scar is formed that
slows muscle growth in length.
Birth injury to the cervical spine or entanglement
Also contributes to GCS muscle damage (rupture, hematoma).
Acute hypoxia and birth asphyxia
Leads to the occurrence of hypoxic encephalopathy, and, as
a consequence, to a violation of nerve conduction in the muscles of the neck.
Causes of Acquired Disease
Acquired torticollis, especially in newborns, occurs
rarely due to the following factors:
- Infectious encephalitis – With inflammation of the head substance
brain nerve conduction is disturbed, including in muscles
- Inflammation of the vertebrae – Tuberculosis, osteomyelitis,
опухолевые процессы могут стать причиной «перекоса» neck.
- Traumatic injury to the cervical spine –
Various hematomas, dislocations and subluxations in vertebral joints
- Cicatricial tightening of the skin on the neck – Typically, after burns or
other skin lesions (cuts, wounds).
- Various secondary diseases – Inflammation of the salivary glands,
pathology of the lower jaw (the GCS-muscle is attached to it).
- Positional torticollis. Characteristic for newborns – firstborn
(mom is not yet fully aware of how to care for a child). With
the long stay of the baby on one side, while the child is lying
in the same position, constantly looking for his mother with his eyes, not
turning heads. The neck muscles get used to the same position as
leads to crooked.
As a rule, obvious signs of torticollis in newborns begin
appear at 2 – 3 weeks of life, which is often their own
parents note. Experienced neonatologist, especially after complicated
of childbirth, the disease may already be suspected in the maternity hospital, but the symptoms in
the first days of the baby’s life are not very pronounced and not all patients
The first characteristic manifestation of pathology is a thickening in the form of
clubs in the middle or lower third of the GCS-muscles (a sign appears on
14 – 21 days after delivery. This thickening is associated with either
by pulling the head during labor in pelvic presentation or with
tear / snapping muscle. Thickening dense at
palpation, there may be edema or hemorrhage around it.
Signs of inflammation around the thickening (redness and
skin temperature in the damaged area) are absent, and the dense
The plot is easily displaced with the rest of the muscles.
The damaged area of the GCS-muscle has clear contours visible
by eye, the maximum increase in thickening occurs by 5 – 6
for weeks. The lateral dimensions of the thickened area reach 2 – 20
see. Then there is a gradual decrease in the thickness of the damaged
a muscle site up to its full disappearance by 4 – 8 months.
But although the thickening and swelling disappear, the muscle remains compacted, which
reduces its elasticity and becomes like a tendon. Whole
The described process leads to a lag in growth compared to
similar muscle from the opposite side and progression
clinical picture of the disease.
Attachment points (lower jaw, sternum, collarbone) GCS-muscles
converge and fixed, which leads to a forced tilt
heads to the affected side (left or right), along with
the child’s head turns in the opposite direction. So
way formed the forced wrong position of the baby’s head
– torticollis. In the case of prevalence of the head tilt
suspect damage to the clavicular foot, and with significant
turning the head in the opposite direction – the sternum is damaged
In children up to 12 months, this neck deformity is pronounced.
insignificantly, which is fraught with consequences in the future in the absence of
treatment. During the period of rapid growth of the child (3 – 6 years) disease
progresses rapidly. Over time increases fixed
tilting and turning the child’s head, which limits
mobility in the cervical spine and the occurrence of secondary changes in
bone skeleton structure. The stronger the damage to the GCS muscle, the
more pronounced changes.
The first changes will affect the facial part of the skull, which
manifested in its asymmetry and unilateral development. Face sizes with
the sides of the lesion decrease in the vertical direction but
will increase in the horizontal (a kind of compression from the top down and
extension to the sides). As a result, the palpebral fissure narrows and
will be slightly below the other eye, will also occur
smoothing the contours of the cheeks and a slight rise in the corner of the mouth. Nose, mouth and
the chin will be located not in a straight line, but along an oblique line,
which has a slope toward the pathology. As a result baby
will seek to set the head vertically due to the high
standing shoulder and shoulder blade. All this leads to the formation
scoliosis in the thoracic and cervical regions, and later scoliosis
transformed into S-shaped, grabbing and lumbar
In the case of the formation of bilateral congenital torticollis with
equivalent shortening of both GKS muscles, the baby has a slope
and pushing the head forward with the formation of cervical lordosis,
limited movement of the head, in particular back and forth, and
somewhat high standing clavicle. If the degree of damage on one
side is more significant than on the opposite, then often
expose the diagnosis of unilateral congenital torticollis.
Memo to parents
To determine a disease in a newborn as early as possible
It is important to remember its main features:
- head tilted back and tilted to one side (often
- face turned in the opposite direction;
- nape sloping;
- blades are located at different levels;
- palpation is determined by a seal of 2 cm or more on
affected muscle in the form of bean or acorn.
Undiagnosed disease and absence or later
initiation of treatment leads to the following consequences of torticollis:
- face asymmetry and deformation;
- spinal curvature: lordosis / kyphosis, scoliosis;
- pain in the spine – osteochondrosis;
- dysfunction of the spine provoke the development
clumsiness, instability and lameness;
- squint due to asymmetry of the face and problems with
- persistent headaches, vascular dystonia, as
the result of spinal curvature and circulatory disorders in
- lag in physical and psycho-neurological development
(the child will sit up late and does not stand up for a long time, begins late
- flat feet;
- cosmetic defect – constantly inclined to the shoulder
The results of treatment depend on the time of its beginning, than before.
the beginning of the fight against the disease, the higher the effect. Treatment
the disease must be complex, long lasting and constant
- physical therapy;
- treatment by position;
- collar treatment;
- exercises in the pool / bath;
- orthopedic styling using orthopedic
Massage при кривошее у ребенка should be performed three times a day,
the duration of each procedure should be 6 to 8 minutes.
- light stroking massage the whole body of the child;
- gently, half-heartedly, knead the affected muscle;
- slightly rub and iron the cheek on the healthy side;
- turn your head slightly one after another
- stroking the abdomen;
- stroking the neck, then lightly kneading all the muscles of the neck;
- massage the feet;
- turn the baby on the tummy;
- stroking the neck and back;
- child lying on his stomach, turn from side to side;
- stroking movements of the arms and legs.
An important rule, massage should begin and end.
stroking, especially problem areas. After each massage
movements (rubbing, kneading, vibration) to perform stroking.
During the massage, special attention is paid to the neck muscles.
Light tweaks, rubbing, kneading, knocking (vibration). With
healthy muscle massage is performed intensively, and from the side
It is useful to carry out massage in a bath with warm water (muscles
achieve optimal relaxation).
You should also constantly monitor the situation of the child,
regardless of his location, in the arms of the mother or in bed.
Treatment положением помогает пассивно растягивать пораженную мышцу.
When a child is put to bed, it is advisable to turn him on
healthy side to the wall, and with a sore hand to put a toy or
light the light The kid will be looking for a toy / light,
turning the head to the sick side.
You should also properly equip the bed of the newborn.
Normal mattress to replace the mattress of medium hardness, and a pillow
remove (you can put in four folded diapers). If a doctor
allow, you can use an orthopedic pillow. Instead
orthopedic pillows are allowed to use sandbags
or salt, wrapped with a cloth, but not more than 2 hours at a time
(used thrice a day). In this case, the child must lie
symmetrically, otherwise the effect will not be. To fix the baby
the same bags or cotton gauze rollers are used which
stacked on both sides of the neck and armpits and pinned up.
With frequent regurgitation of the newborn, this method does not apply.
(then lay the child on its side).
It is also important to wear a baby properly. When taking the child to
arms should be held upright and chest pressed to
to myself. And the shoulders of the baby should be on the same level with
mother’s shoulders. With smooth movements, turn the child’s head
the side of torticollis and squeeze the cheek. Frequent laying out baby on
the tummy will make him raise his head all the time and work out
Physical therapy needs to be combined with massage and
physiotherapy. Exercises can be done at home, but for their
need 2 people. Since these exercises are painful for
child, they need to perform smoothly and without applying force. Before
the beginning of classes should be instructed by a specialist in physical therapy.
One person must hold the body and arms of the baby, the second
man holds the head. Baby should be placed on the edge
the table so that his shoulders are parallel to the edge and his head is
time to hold. Gently lower the head down, holding it,
limiting the turn and tilt to the sore side. Then smoothly
raise the head until it touches the chin
chest Repeat 5 – 8 times.
The child should be put on the table on a healthy side, the head should be behind
outside the table. One parent holds the baby, the other
supports the head. First, weaken the support of the head, so
way the affected muscle is stretched. Then head start
lift up. Repeat the exercise 4 to 8 times.
Уложить младенца на спину, голова за outside the table.
Produce head tilts in the direction of a healthy shoulder. Try (but
not much) reach the ear shoulder. The slopes are repeated 2 – 3 times, and
after performing tilt to the affected side 1 time. Repeat in
ratio: 3 times in the healthy direction, 1 time in the patient. General
number of cycles 5 – 8.
Take the child in your arms while holding it vertically. Head
support from the back, then reduce support until complete
свешивания головки до chest Raise your head again, support
some time and repeat the exercise. Run up to 5 times thrice a
Activities in the bath / pool
Water exercises in the bath are performed with children up to a year. For
This use a special rubber ring, which is put on
neck baby, fixing the head in a raised position (damaged
muscle unbent). For детей старшего возраста полезны занятия в
pool with instructor or parents:
- place the hands of the parent under the nape of the baby that lies on
back, while stroking the thumb pads
- the child is on his back, smoothly moving his head then into
одну, то в другую side;
- the child is lying on his stomach, the parent supports him for
chin and leads along the pool and the other hand smoothly springy
to hold the raised shoulder girdle in the water.
From physiotherapeutic procedures with muscle mass
origin effective electrophoresis of the affected muscle with
iodine preparations. Paraffin and infrared treatments are also used.
For surgical treatment resorted to the ineffectiveness
conservative therapy, which is observed in 20 40% of cases. Operation
perform in 3 – 4 years. Possible surgical treatment
- dissection of the affected muscle;
- plastic (lengthening) GCS-muscles.
But surgical treatment is fraught with complications – the formation
scar tissue that only exacerbates the problem. Therefore, after
operations the child must be registered with the orthopedist and, and parents
должны выполнять все консервативные методики treatment.
Is it possible and necessary to use a special Shantsu collar for
Yes, such treatment is welcome, but subject to the conditions.
Wearing a collar should only recommend a doctor, he and
selects the required size, shows how to wear it correctly and
take off. Wearing a collar should be combined with others.
conservative techniques, and wear it to secure success
after physiotherapy, massage and therapeutic exercises. Start off
Collar wearing is possible from 7 months of age.
How to choose the orthopedic pillow for the baby?
First, you should focus on the filler, it should
be breathable, if the child turns face down,
will not suffocate. Secondly, you need to inspect the seams of the pillow, they should
be well stitched and tucked inside, filler through the seams
should not speak. Third, inspect the pillow cover, from which
Ying fabric is made. Preferably natural (cotton or linen), such
pillows are easy to wash. And last, choose pillows with
hypoallergenic filler (holofiber, sintepon).
How to prevent the development of torticollis in a newborn?
The risk group for the occurrence of the disease includes moms with
complicated childbirth, various previous infections during
pregnancy, as well as children born in pelvic presentation.
It should be immediately after discharge from the hospital to begin prevention
diseases. As often as possible to lay the baby on the stomach, hold
daily light body massage, focusing on the neck,
perform recreational gymnastics, alternating slopes with turns
heads, play with the child so that he alternately turns
head in one way or the other.