🦴 Chapter 721 · The Neck

Nelson Textbook of Pediatrics 22nd Edition | Congenital Muscular Torticollis (CMT): sternocleidomastoid contracture, head tilt to ipsilateral side, chin to contralateral side. Associated with plagiocephaly, DDH (8-20%). Treatment: physical therapy (stretching), early referral. Klippel-Feil syndrome: congenital fusion of cervical vertebrae, short neck, low hairline, limited motion. Associated with scoliosis, renal anomalies, hearing loss. Atlantoaxial rotatory displacement (AARD/Grisel syndrome): post-infectious or post-traumatic, fixed rotation, 'cock-robin' deformity. Cervical instability: Down syndrome (ADI >4.5mm), os odontoideum, 22q11.2 deletion syndrome.

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📋 30 Clinical Scenarios — Neck Disorders

📇 High‑Yield Review Cards

🩺 Clinical Recognition: Neck Disorders

Select a presentation to review diagnostic clues and management per Nelson Ch 721.

📋 Stepwise Management of Neck Disorders

🔑 Key Principles — Nelson Chapter 721
• Congenital Muscular Torticollis (CMT): Start physical therapy (stretching) within first 3 months → near 100% resolution. Associated with DDH (8-20%) → hip ultrasound. Plagiocephaly common.
• Klippel-Feil syndrome: MRI cervical spine, renal ultrasound, echocardiogram, hearing screen. Monitor for cervical instability.
• Atlantoaxial rotatory displacement (AARD): Pain, head tilt, contralateral SCM spasm. Dynamic CT rotation. Treat with analgesia, soft collar, traction if persistent.
• Down syndrome cervical instability: ADI >4.5mm on flexion/extension radiographs. MRI for neurologic symptoms. Avoid contact sports.

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: The Neck (Nelson 721)