A 6-week-old infant is brought because the head tilts to the right with the chin rotated to the left. Examination shows a firm, non-tender 2 cm mass within the right sternocleidomastoid muscle, and passive rotation of the neck to the right is restricted. There are no neurological deficits. The most appropriate initial management is:
- A Immediate release of the sternocleidomastoid muscle
- B Passive stretching exercises taught to the parents ✓
- C Cervical spine MRI before any intervention
- D Botulinum toxin injection into the affected muscle
Correct answer: B. Passive stretching exercises taught to the parents
Explanation
This is congenital muscular torticollis with a sternocleidomastoid pseudotumour. The head tilts toward the affected side and the chin rotates away. About 90% resolve with a programme of passive stretching started in the first months of life, so physiotherapy is the initial treatment. Surgery is reserved for cases persisting beyond about one year despite stretching. MRI is unnecessary when the clinical picture is typical.
Reference: Tachdjian's Pediatric Orthopaedics, 5th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.