ugs are useful in relieving the
pain.

#Permanent# or #true wry-neck# is due to an organic shortening of the
sterno-mastoid muscle. The trapezius, the splenius, the scaleni, and
the levator scapulae muscle may also undergo shortening, along with
their investing sheaths derived from the cervical fascia.

The sternal head of the sterno-mastoid is always markedly shortened,
and stands out as a tight cord; sometimes the clavicular head is also
prominent.

There is evidence that in the majority of cases the deformity results
from some interference with the development of the muscles during
intra-uterine life. This is probably the effect of undue pressure on
the foetus diminishing the arterial supply to the central part of the
muscle, with the result that the muscle fibres undergo degeneration
with subsequent sclerosis and contraction. It may result also from
cicatricial contraction of the muscle following rupture of its fibres
during delivery. In such cases there is a history that the birth was a
difficult one, the presentation having been abnormal; and that a
swelling was observed in the sterno-mastoid shortly after birth. This
swelling--_a haematoma of the sterno-mastoid_--is at first soft, later
becomes smaller, and eventually disappears. In course of time,
sometimes months, sometimes years after the disappearance of the
swelling, shortening of the muscle takes place, and the deformity is
established.

_Clinical Features._--Although the condition is usually described as
"congenital," it is the common experience in practice that the child
has reached the age of from seven to ten years before advice is
sought. The appearance of the patient is characteristic (Fig. 271).
The shortening of the sterno-mastoid pulls the head towards the
affected side, usually the right, so that the ear is approximated to
the shoulder. At the same time the head is rotated towards the
opposite side and slightly tilted backwards, with the result that the
chin is directed towards the opposite side, and is somewhat raised.
The shortened sterno-mastoid stands out prominently, and, on any
attempt to straighten the head, can be felt as a firm, fibrous band.
The skin of the affected side of the neck may be thrown into
transverse folds. The patient is unable to correct the deformity, but
it is usually possible to diminish it by manipulation.

[Illustration: FIG. 271.--Congenital Wry-neck in a boy aet. 14.]

If the condition is not corrected, all t