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 and a possible further investigation with different imaging depending on the etiology. Unnecessary X-rays expose patients to ionizing radiation, including high costs for society and environmental harm. The acronym PINCH serves as a new clinical tool to identify the cause: P = physical (e.g., mass); I = intracranial (e.g., hypertension); N = neural causes; C = cervical spine abnormalities; H = hematologic/infectious causes. Depending on the cause, imaging modalities — ultrasound, X-ray, CT, or MRI — can be used as definitive or complementary techniques.

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