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Torticollis (Wry Neck): Causes and Treatment

Torticollis, also known as wry neck, is a condition in which the head is persistently tilted or rotated to one side. It can be congenital or acquired.

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Things worth knowing about "Torticollis"

Torticollis, also known as wry neck, is a condition in which the head is persistently tilted or rotated to one side. It can be congenital or acquired.

What is Torticollis?

Torticollis, commonly called wry neck or by its Latin name Caput obstipum, is a condition characterized by an abnormal, asymmetrical head or neck position. The head may be tilted, rotated, or flexed to one side either persistently or intermittently. Torticollis can affect people of all ages and arises from a variety of underlying causes. It is broadly classified into congenital and acquired forms.

Causes

Congenital Torticollis

Congenital muscular torticollis typically results from shortening or fibrosis of the sternocleidomastoid muscle, the large muscle on the side of the neck. This may be caused by birth trauma, abnormal fetal positioning in the womb, or impaired blood supply to the muscle during delivery.

Acquired Torticollis

Acquired torticollis has a range of possible causes:

Muscular torticollis: Muscle spasm, strain, or injury in the neck region
Neurogenic torticollis: Nervous system disorders such as stroke or Parkinson disease
Osseous torticollis: Abnormalities or degenerative changes of the cervical spine
Spasmodic torticollis (cervical dystonia): Involuntary muscle contractions caused by a movement disorder originating in the brain
Ocular torticollis: Head tilt compensating for strabismus or other eye muscle imbalances
Inflammatory torticollis: Due to infections or inflammation in the neck or throat area

Symptoms

Common signs and symptoms of torticollis include:

Persistent or recurring tilting or rotation of the head to one side
Neck and shoulder pain
Restricted range of motion in the cervical spine
Muscle tension and palpable muscle hardening
In infants: preference for turning the head to one side, difficulty feeding from one breast
In severe cases: headaches, dizziness, or visual disturbances

Diagnosis

Diagnosis of torticollis involves:

Physical examination: Assessment of head posture, muscle function, and neck mobility
Imaging studies: X-ray, ultrasound, or MRI of the cervical spine and neck muscles to identify underlying causes
Neurological evaluation: To rule out neurological causes
Ophthalmological examination: When ocular torticollis is suspected

Treatment

Conservative Treatment

Many cases of torticollis respond well to conservative management:

Physiotherapy: Stretching and strengthening exercises to improve muscle balance and range of motion
Manual therapy and osteopathy: Targeted treatment of muscles and joints
Heat or cold therapy: To relieve pain and muscle tension
Medications: Muscle relaxants, pain relievers, or anti-inflammatory drugs as needed

Botulinum Toxin Therapy

For spasmodic torticollis (cervical dystonia), injections of botulinum toxin (Botox) into the affected muscles have proven highly effective. The effect typically lasts several months and must be repeated regularly for ongoing symptom control.

Surgical Treatment

In severe congenital cases or when conservative treatment fails, surgery may be required to lengthen the shortened muscle or correct structural abnormalities of the cervical spine.

Treatment in Infants

In newborns and infants with congenital muscular torticollis, physiotherapy with gentle stretching exercises should be started as early as possible. Parents are guided to perform these exercises at home on a daily basis. With early and consistent treatment, full correction is achieved in the vast majority of cases.

References

German Neurological Society (DGN): Guidelines on Cervical Dystonia (Spasmodic Torticollis) - Diagnosis and Treatment, 2023.
Bhatt JM, Ibrahim S, Bhatt M. Torticollis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
Piazza C, Mocellin M, Nicolai P. Congenital muscular torticollis: natural history and management. European Archives of Oto-Rhino-Laryngology, 2021.

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