The diagnosis of torticollis is clinical. Congenital torticollis is usually diagnosed within the first month of life; diagnosis after 6 months is rare and other causes must be considered. In the newborn or suckling infant, the main cause is muscular and the imaging method of first choice is ultrasound. In older children, the onset of torticollis without trauma recognizes various causes (headache, muscle spasm, infections, autoimmune disease, neoplasms, dystonic syndromes, ocular dysfunctions) and therefore requires an adequate clinical framework and possible further investigation with MR imaging (preferable) or CT; in these situations the X-ray has a limited role, being able to identify only skeletal anomalies or atlanto-axial instabilities which in any case would require subsequent evaluation with level II imaging.

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