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Torticollis in childhood—a practical guide for initial assessment

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Abstract

Torticollis is encountered often in the paediatric setting and should be considered a presenting symptom, rather than a diagnosis. Aetiologies of torticollis are numerous, and the nomenclature describing underlying diagnosis can be confusing. Furthermore, children with torticollis typically present in the first instance to primary or secondary care rather than to the subspecialist. These factors can contribute to erroneous treatment of this patient-group which could be time critical in some instances. In this review, we discuss the common causes for torticollis and propose a simple clinical assessment tool and early management scheme that will assist in the differential-diagnosis and treatment pathway of this challenging condition.

Conclusion: Torticollis can be the initial presentation of various conditions. The diagnosis and management tools provided in this article can aid in guiding paediatricians as to the correct initial management, imaging, and specialist referral.

What is Known:

• Torticollis in childhood is a very common presenting symptom with numerous aetiologies.

• Management is complex, requires multiple clinical and imaging examinations, and is usually performed by non-specialized professionals.

What is New:

• A new, simple clinical-assessment tool under the acronym PINCH designed to aid paediatric general practitioners in diagnosing correctly the aetiology of torticollis.

• A practical management scheme to aid in the treatment pathway of children with torticollis.

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Abbreviations

AARF:

Atlanto-axial rotatory fixation

BPTI:

Benign paroxysmal torticollis of infancy

CT:

Computed tomography

ENT:

Ear-nose-throat

MRI:

Magnetic resonance imaging

OAVS:

Oculo-acoustic vertebral spectrum

PINCH:

Pain, intermittent, neurology, congenital, head shape

US:

Ultrasound

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Acknowledgements

Hila Rawet Karni, BSc.

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Authors and Affiliations

  1. Paediatric Neurosurgery Department, Great Ormond Street Hospital, London, UK

    Ido Ben Zvi & Dominic N. P. Thompson

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  1. Ido Ben Zvi
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  2. Dominic N. P. Thompson
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Ido Ben Zvi-Conceptualization, writing–original draft. Dominic NP Thompson-Conceptualization, writing—review and editing, supervision.

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Correspondence to Ido Ben Zvi.

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Ben Zvi, I., Thompson, D.N.P. Torticollis in childhood—a practical guide for initial assessment. Eur J Pediatr 181, 865–873 (2022). https://doi.org/10.1007/s00431-021-04316-4

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