| Condition | Clinical features |
| Other causes of head tilt or postural preference |
| Musculoskeletal anomalies |
| Klippel-Feil syndrome | - Congenital fusion of variable numbers of cervical vertebrae resulting in short neck, low posterior hairline, and variably limited neck motion
- Associated defects include elevation of the scapula, scoliosis, renal anomalies, congenital heart disease, and deafness
|
| Congenital scoliosis | - Lateral deviation of the spine associated with congenital vertebral malformation (eg, hemivertebra, wedge vertebra, etc)
- Often associated with intraspinal abnormalities (eg, myelomeningocele) and abnormalities of other organ systems
|
| Hemivertebra | - Congenital vertebral malformation
- May be associated with congenital scoliosis and abnormalities of other organ systems
|
| C1-C2 rotary displacement | - Tightness of SCM muscle on the side to which the chin is rotated (rather than the opposite side as in congenital muscular torticollis)
|
| Clavicle fracture | - Asymmetry of clavicles, crepitus, decreased/absent movement of the arm, crying with movement of the arm
|
| Unilateral absence of SCM | - Asymmetric contours of the neck, prominent ipsilateral clavicle, normal range of motion of the neck
|
| Ocular torticollis |
| 4th cranial nerve palsy | - Vertical strabismus, limited EOM (impaired ability to look down and medially with the affected eye)
|
| Brown syndrome | - Vertical strabismus, limited EOM (impaired ability to look up with the affected eye)
|
| Congenital fibrosis of the extraocular muscles | - Vertical strabismus, limited EOM (impaired ability to look up with the affected eye), ptosis; family members may be similarly affected
|
| Duane syndrome | - Horizontal strabismus, limited EOM (impaired ability to look laterally with the affected dye)
|
| Spasmus nutans | - Triad of nystagmus, head nodding/shaking, and torticollis
|
| CNS abnormalities |
| Chiari type II malformation (Arnold-Chiari malformation) | - Downward displacement of the inferior cerebellar vermis, cerebellar tonsils, and medulla through the foramen magnum in association with myelomeningocele
- May be associated with dysphagia, arm weakness, stridor, apnea, or aspiration
- May be associated with syringomyelia and scoliosis
|
| Neonatal encephalopathy | - Associated abnormalities may include abnormal state of consciousness, diminished spontaneous movements, respiratory or feeding difficulties, poor tone, absent primitive reflexes, seizures
|
| Posterior fossa tumor | - Abnormal neurologic findings (eg, cranial nerve palsy, recurrent vomiting)
|
| Miscellaneous |
| Benign paroxysmal torticollis | - Recurrent episodes that may alternate from side to side
- Episodes typically last for hours
- Usually presents in the first few months of life
- Often accompanied by vomiting, pallor, irritability, ataxia, or drowsiness
|
| Other causes of limited cervical range of motion |
| Pterygium colli | - Web of skin that extends from the acromial process to the mastoid
- May occur in trisomy 18, Turner syndrome, Noonan syndrome
|
| Other neck masses |
| Cystic hygroma | - Mass is cystic and transilluminates
|
| Other causes of plagiocephaly |
| Unilateral lambdoid craniosynostosis | - Palpable ridge along affected suture, head is shaped like a trapezoid when viewed from above
|
| Unilateral coronal craniosynostosis | - Palpable ridge along affected suture, anterior flattening of the skull, posterior skull is normal
|
