Torticollis

Wry Neck

What is Torticollis?

Torticollis is a twisted neck (cervix) from prolonged, involuntary muscle contractions (dystonia). Cervical dystonia may pull the neck forward (anterocollis), backward (retrocollis), or tilt the head toward the shoulder (laterocollis). The muscle contractions may be sustained (tonic), jerky (clonic), or a mixture of both.

The condition may occur without known cause (idiopathic), be genetic, or be acquired secondary to damage to the nervous system or muscles. It may develop in childhood (rarely) or adulthood. Congenital torticollis (present at birth) may be caused by malpositioning of the head in the uterus or by prenatal injury of the muscles or blood supply in the neck.

How is it diagnosed?

History: The individual may complain of headache, neck stiffness and pain.

Physical exam may reveal a visible shortening of the neck muscles and the head will tilt toward the affected side while the chin points to the opposite side.

Tests: There are no specific tests for torticollis other than those that could rule out other possible diagnoses.

How is Torticollis treated?

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.
  • Various drug treatments may be utilized.
  • Specialized centers inject the involved muscle with botulism toxin to temporarily paralyze the muscle (for months).
  • Surgical treatments are sometimes used to resect a nerve.
  • Spontaneous recovery without treatment occurs in most mild cases.

Medications

  • Anticholinergics, benzodiazepines, muscle relaxants, or tricyclic antidepressants are drug possibilities that may be prescribed.
  • Multiple injections of botulinum toxin type A into the neck muscles may be prescribed.
Information Brand Generic Label Rating
http://www.nmihi.com/b/baclofen.html Lioresal Baclofen Off-Label

Tegretol(Carbamazepine), Klonopin (Clonazepam), Valium (Diazepam), Ativan (Lorazepam)

What might complicate it?

A possible complication is neurological symptoms of numbness and tingling sensations from compressed nerve roots. Individuals with prolonged torticollis may develop degenerative osteoarthritis of the cervical spine and hypertrophy of the sternocleidomastoid muscle.

Predicted outcome

Cases vary from mild to severe disease, but the course is usually a slow progression for one to five years. In more severe cases, torticollis may persist for life and can result in restricted movement and postural deformity.

Alternatives

There are no other possible diagnoses.

Rehabilitation

Physical therapy, or chiropractic treatment, three times a week, for a period of two to four weeks.

Appropriate specialists

Neurologist.

Notify your physician if

  • Your infant has symptoms of torticollis.
  • You have neck pain or spasms that persist longer than 1 week.

Last updated 15 December 2011


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