A 5-week-old boy is brought for a fixed head tilt to the right with chin turned to the left. There is a firm, non-tender fusiform mass within the right sternocleidomastoid muscle, and facial asymmetry is beginning to appear. What is the most appropriate management?

• A MRI of the cervical spine followed by surgical tenotomy
• B Passive stretching exercises of the sternocleidomastoid with screening of the hips ✓
• C Observation alone, as all cases resolve spontaneously by school age
• D Immediate open release of the muscle origin and insertion

Explanation

This is congenital muscular torticollis with a sternocleidomastoid pseudotumor. First-line treatment in infancy is gentle passive stretching performed by parents, which resolves most cases when started before one year; surgery is reserved for persistent contracture beyond that age. Because congenital muscular torticollis is associated with developmental dysplasia of the hip in about 10 percent of cases, every such infant must have clinical and often ultrasound hip screening.

Reference: Tachdjian's Pediatric Orthopaedics, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.