THE PREVALENCE OF NONMUSCULAR CAUSES OF TORTICOLLIS IN CHILDREN

Torticollis in children may result from a wide variety of pathologic p rocesses. We retrospectively analyzed 288 patients seen in a tertiary care pediatric orthopedic facility for the evaluation of torticollis o ver a 10-year period to ascertain the frequency of nonmuscular causes of this condition. Fifty-three of these children (18.4% of the study p opulation) had a nonmuscular etiology for their torticollis. Of these 53 patients, Klippel-Feil anomalies were present in 16 (30%), and an u nderlying neurologic disorder was present in 27 (51%). These neurologi c conditions included ocular disorders in 12 (23%) patients, brachial plexus palsies in nine (17%) patients, and lesions involving the centr al nervous system in six (11%) patients. We conclude that nonmuscular causes of torticollis are collectively not rare. In a child without an identifiable muscular etiology for torticollis, Klippel-Feil anomalie s or an underlying neurologic disorder is likely to be the cause of th e deformity in the majority of patients.