patient’s radiographs but should be considered if the head cannot be rotated past midline Rotary subluxation or displacement may be spontaneous or follow an upper respiratory tract infection or traumatic event with variable severity These patients rarely present with abnormal neurologic findings In these patients, their chin will often point to the same side as the SCM spasm giving the child the typical (cock robin) position This presentation is logical considering that the SCM muscle is attempting to reestablish normal neck position Radiographs may be useful to help distinguish between muscular torticollis and rotary subluxation, although the radiographs may be normal in both cases ( Figs 112.32 and 112.33 ) Rotary subluxation should be suspected if, on an open-mouth radiograph, one of the lateral masses of C1 appears forward and closer to the midline whereas the opposite lateral mass appears narrow and away from the midline (lateral offset) A CT scan is the most useful diagnostic tool in rotary subluxation ( Fig 112.33 ) Patients with mild rotary subluxation should be treated with a cervical collar and analgesia for comfort, whereas those with moderate or resilient rotary displacement may need immobilization, traction, or surgical intervention If anterior displacement of C2 on C1 is present, longer immobilization may be needed to allow injured ligaments to heal