Chiropractic Management of Infantile Torticollis With Associated Abnormal Fixation of One Eye: A Case Report
SOURCE: J Chiropr Med 2015 (Mar); 14 (1): 51-56
Mette Hobaek Siegenthaler, DC, MSc
Swiss Academy for Chiropractic,
OBJECTIVE: The purpose of this case report is to describe the chiropractic management of a child with abnormal fixation of one eye and torticollis.
CLINICAL FEATURES: A mother presented with a concern regarding her 23-month-old son who had a history of torticollis and an abnormal fixation of the right eye. She noticed the head tilt when he was about 7 months old and abnormal alignment of the right eye when the boy was 18 months old. At 15 months when he took his first steps, his head tilt became worse. At 21 months old, a neurological and orthopedic examination at the regional university children`s hospital ruled out presence of a tumor of the cervical spine or posterior fossa. The orthopedist sent the baby for chiropractic evaluation and treatment. Chiropractic exam found decreased active and passive range of motion in the cervical spine and no evidence of mass or contracture of the sternocleidomastoid muscle. Segmental palpation showed a decreased joint play and pain reaction at level C1/C2 on the right.
INTERVENTION AND OUTCOME: The chiropractic treatment consisted of spinal manipulative therapy of the cervical spine in addition to massage and stretching of the neck muscles. Within a period of 4 weeks (3 chiropractic treatments) the torticollis was nearly resolved and the abnormal fixation of the right eye was no longer apparent. No relapse of the symptomatology was observed at a follow-up consultation at 26 months.
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CONCLUSION: The patient responded favorably to chiropractic care, showing a possible mechanical spinal cause for his torticollis and for the secondarily developed abnormal fixation of the right eye.
KEYWORDS: Chiropractic; Manipulation; Ocular motility disorders; Spinal; Strabismus; Torticollis
From the FULL TEXT Article:
The term torticollis means twisted neck and is derived from the Latin words “tortus” and “collum”.  The condition stems from a musculoskeletal problem or an underlying non-musculoskeletal pathology.  Musculoskeletal reasons for infantile torticollis include a tumor in the sternocleidomastoid muscle (SCM), an imbalance in the neck musculature or a dysfunction in the craniocervical junction.  In addition, abnormalities of the cervical spine, like the Klippel-Feil syndrome, can cause torticollis.  The non-musculoskeletal reasons for infantile torticollis could be ocular, neurological or due to auditory problems. 
The most common ocular causes of torticollis in all population ages are a congenital paralytic squint and congenital nystagmus.  Kuschner [6, 7] stated that the underactivity of the superior oblique muscle is the most common ocular cause of torticollis in all ages. It is also stated by Kekunnaya  that 74% of all patients with unilateral paresis of the superior oblique muscles have torticollis. In a patient with true ocular torticollis, the condition results from the body trying to assist its vision in one or more ways:  to improve vision, to bring the field of vision into a central area, to reduce eye discomfort, to strengthen binocular vision and to protect and relieve the eye from pain. With unilateral paresis of the superior oblique muscle the eye looks up and in slight adduction when looking straight ahead; a child will usually flex its neck laterally to the opposite side to compensate, but variations can occur. 
The reported prevalence of congenital muscular torticollis with a tumor in the SCM has ranged from 0.3% to 2%.  The prevalence of muscular imbalance and dysfunction in the craniocervical junction causing torticollis is unknown.
The prevalence of the non-musculoskeletal causes of torticollis in children is unknown. Ballock (1996)  studied 288 subjects with a mean age of 22.7 months and found that non-musculoskeletal causes of torticollis accounted for 18.4% of the total. Of all the non- musculoskeletal causes 22.6% had ocular etiology. Another study, a prospective consecutive case series from 2005,  investigated the prevalence of different causes of torticollis in children presenting to primary care pediatricians. Of the 29 patients below the age of one year, 19 had orthopedic etiology, 4 ocular and 6 unknown problems. This is a small number of patients, but is, however, the only prospective study done on the prevalence of torticollis in infants.
Musculoskeletal and non-musculoskeletal torticollis can cause secondary functional deficits like unilateral breastfeeding problems and asymmetrical use of their hands.  In addition, changes in form can develop because of torticollis, such as deformational plagiocephlay, facial scoliosis and infantile scoliosis. [2, 14]
There is a paucity of literature investigating or reporting on the chiropractic management of ocular torticollis in children. Therefore, this case report presents a case where abnormal fixation of one eye developed as a secondary complication to torticollis.