Torticollis

Answer 1

Definition

Torticollis is a twisted neck in which the head is tipped to one side, while the chin is turned to the other.

Alternative Names

Wry neck; Loxia

Causes, incidence, and risk factors

Torticollis may be:

• Inherited: Due to specific changes in your genes
• Acquired: Develops as a result of damage to the nervous system or muscles

If the condition occurs without a known cause, it is called idiopathic torticollis.

Torticollis may develop in childhood or adulthood. Congenital torticollis (present at birth) may occur if the fetus' head is in the wrong position while growing in the womb, or if the muscles or blood supply to the fetus' neck are injured.

Symptoms

• Limited range of motion of the head
• Headache
• Head tremor
• Neck pain
• Shoulder is higher on one side of the body
• Stiffness of neck muscles
• Swelling of the neck muscles (possibly present at birth)

Signs and tests

Various tests or procedures may be done to rule out possible causes of head and neck pain. A physical examination will show a visible shortening of the neck muscles and the head will tilt toward the affected side while the chin points to the opposite side. In more severe cases, the entire head pulls and turns to one side

A electromyogram(EMG) may be done in mild cases to see which muscles are most affected.

Treatment

Treatment of congenital torticollis involves stretching the shortened neck muscle. Passive stretching and positioning are treatments used in infants and small children. Such treatments are often successful, especially if started within 3 months of birth.

Surgery to correct the neck muscle may be done in the preschool years, if other treatment methods fail.

Acquired torticollis is treated by identifying the underlying cause of the disorder. Application of heat, traction to the cervical spine, and massage may help relieve head and neck pain. Stretching exercises and neck braces may help with muscle spasms.

Medications used to treat this condition include an anticholinergic drug called baclofen. Injection of botulinum toxin can temporarily relieve the torticollis, but repeat injections every 3 months are usually needed. Surgery is rarely used.

Expectations (prognosis)

The condition may be easier to correct in infants and children. If the condition becomes chronic, numbness and tingling may develop as nerve roots become compressed in the neck.

The muscle itself may become large (hypertrophic) due to constant stimulation and exercise.

Botulinum toxin injections often provide substantial relief.

Complications

Complications may include:

• Muscle swelling due to constant tension
• Neurological symptoms due to compressed nerve roots

Calling your health care provider

Call for an appointment with your health care provider if symptoms do not improve with treatment, or if new symptoms develop.

Torticollis that occurs after an injury or with illness may be serious. Seek immediate medical help if this occurs.

Prevention

While there is no known prevention, early treatment may prevent a worsening of the condition.

References

Spiegel DA, Hosalkar HS, Dormans JP, Drommond DS. The neck. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap. 679.

Persing J. Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery. Pediatrics. 2003;112:199-202.

Patel M, Shah K. Orthopedics. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 42.

Answer 2

Definition

Torticollis is a twisted neck in which the head is tipped to one side, while the chin is turned to the other.

Alternative Names

Wry neck; Loxia

Causes, incidence, and risk factors

Torticollis may be:

• Inherited: Due to specific changes in your genes
• Acquired: Develops as a result of damage to the nervous system or muscles

If the condition occurs without a known cause, it is called idiopathic torticollis.

Torticollis may develop in childhood or adulthood. Congenital torticollis (present at birth) may occur if the fetus' head is in the wrong position while growing in the womb, or if the muscles or blood supply to the fetus' neck are injured.

Symptoms

• Limited range of motion of the head
• Headache
• Head tremor
• Neck pain
• Shoulder is higher on one side of the body
• Stiffness of neck muscles
• Swelling of the neck muscles (possibly present at birth)

Signs and tests

Various tests or procedures may be done to rule out possible causes of head and neck pain. A physical examination will show a visible shortening of the neck muscles and the head will tilt toward the affected side while the chin points to the opposite side. In more severe cases, the entire head pulls and turns to one side

A electromyogram(EMG) may be done in mild cases to see which muscles are most affected.

Treatment

Treatment of congenital torticollis involves stretching the shortened neck muscle. Passive stretching and positioning are treatments used in infants and small children. Such treatments are often successful, especially if started within 3 months of birth.

Surgery to correct the neck muscle may be done in the preschool years, if other treatment methods fail.

Acquired torticollis is treated by identifying the underlying cause of the disorder. Application of heat, traction to the cervical spine, and massage may help relieve head and neck pain. Stretching exercises and neck braces may help with muscle spasms.

Medications used to treat this condition include an anticholinergic drug called baclofen. Injection of botulinum toxin can temporarily relieve the torticollis, but repeat injections every 3 months are usually needed. Surgery is rarely used.

Expectations (prognosis)

The condition may be easier to correct in infants and children. If the condition becomes chronic, numbness and tingling may develop as nerve roots become compressed in the neck.

The muscle itself may become large (hypertrophic) due to constant stimulation and exercise.

Botulinum toxin injections often provide substantial relief.

Complications

Complications may include:

• Muscle swelling due to constant tension
• Neurological symptoms due to compressed nerve roots

Calling your health care provider

Call for an appointment with your health care provider if symptoms do not improve with treatment, or if new symptoms develop.

Torticollis that occurs after an injury or with illness may be serious. Seek immediate medical help if this occurs.

Prevention

While there is no known prevention, early treatment may prevent a worsening of the condition.

References

Spiegel DA, Hosalkar HS, Dormans JP, Drommond DS. The neck. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap. 679.

Persing J. Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery. Pediatrics. 2003;112:199-202.

Patel M, Shah K. Orthopedics. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 42.

Reviewed By

Review Date: 06/01/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.