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M43.6 Torticollis (Wryneck) – Causes and Treatment
M43.6 is the ICD-10 code for torticollis (wryneck), a condition in which the head is tilted and rotated due to muscle or structural abnormalities of the neck.
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M43.6 is the ICD-10 code for torticollis (wryneck), a condition in which the head is tilted and rotated due to muscle or structural abnormalities of the neck.
What is M43.6 – Torticollis (Wryneck)?
M43.6 is the official diagnostic code under the International Classification of Diseases (ICD-10) for torticollis, commonly known as wryneck. It describes a condition in which the head is persistently or intermittently tilted to one side and rotated toward the opposite side due to abnormalities of the neck muscles or cervical spine. Torticollis can occur in newborns as well as in adults and may be caused by a wide range of underlying conditions.
Causes
Torticollis can be either congenital (present at birth) or acquired during life. The most common causes include:
- Congenital muscular torticollis: Shortening or fibrosis of the sternocleidomastoid muscle due to birth trauma or intrauterine malposition.
- Spasmodic torticollis (cervical dystonia): Involuntary muscle contractions of the neck muscles of neurological origin.
- Reflex torticollis: Occurs as a protective response to inflammatory conditions such as lymph node swelling, pharyngitis, or otitis media.
- Osseous torticollis: Caused by vertebral malformations or injuries in the cervical region.
- Psychogenic torticollis: Rare; triggered by psychological factors.
- Drug-induced torticollis: As a side effect of certain medications, particularly antipsychotics.
Symptoms
The clinical presentation varies depending on the cause and severity. Typical symptoms include:
- Lateral tilting of the head (lateral flexion)
- Rotation of the head toward the opposite side
- Pain and tension in the neck muscles
- Restricted range of motion of the cervical spine
- In infants: preferred head turning to one side, asymmetrical skull shape (plagiocephaly)
- Headaches (in acquired forms)
Diagnosis
The diagnosis of M43.6 is made clinically and confirmed by imaging studies:
- Physical examination: Assessment of head posture, muscle tone, and range of motion.
- X-ray of the cervical spine: To rule out bony causes.
- Ultrasound: Particularly useful in infants to visualize the sternocleidomastoid muscle.
- MRI or CT scan: When structural or neurological causes are suspected.
- Neurological examination: To exclude a central nervous system origin.
Treatment
Treatment is guided by the underlying cause:
Conservative Measures
- Physiotherapy: Stretching and strengthening exercises to correct muscle imbalances, especially in congenital torticollis.
- Osteopathy and manual therapy: To improve range of motion.
- Heat therapy and electrotherapy: For pain relief and muscle relaxation.
Medical Treatment
- Botulinum toxin injections: Standard treatment for spasmodic torticollis (cervical dystonia) to inhibit overactive muscles.
- Muscle relaxants and analgesics: For symptomatic relief in acute torticollis.
- Anticholinergics or dopamine antagonists: For drug-induced forms.
Surgical Treatment
- In severe congenital or osseous torticollis, surgical intervention may be required (e.g., myotomy, spinal stabilization).
Prognosis
With early and consistent treatment, the prognosis for congenital torticollis is generally favorable. Spasmodic torticollis often requires long-term management with botulinum toxin. If left untreated, permanent deformity and secondary spinal complications may develop.
References
- World Health Organization (WHO): ICD-10 Version 2019, Chapter XIII – M43.6 Torticollis.
- Albanese A. et al.: Phenomenology and classification of dystonia: a consensus update. Movement Disorders, 2013; 28(7): 863–873.
- Carenzio G. et al.: Early rehabilitation treatment in newborns with congenital muscular torticollis. European Journal of Physical and Rehabilitation Medicine, 2015; 51(5): 539–545.
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