Torticollis

Overview

Torticollis means “wry neck” and is a condition that can be either congenital (from birth), or acquired later in life.

A common form of the acquired condition is spasmodic torticollis: a chronic neurological movement disorder causing the neck to turn involuntarily to the left, right, upward or downward. The condition, also known as cervical dystonia, involves sustained muscle contractions that cause repetitive, twisting movements and abnormal postures.

Spasmodic torticollis is categorized by early age of onset (diagnosed before the age of 27) or late age of onset, and by cause. Torticollis can be further classified by the position of the head.
  • Torticollis: head turns horizontally (chin-to-shoulder)
  • Laterocollis: head tilts from side to side (ear-to-shoulder)
  • Anterocollis: head tilts forward (chin-to-chest)
  • Retrocollis: head tilts back (chin-in-the-air)
Many people with torticollis experience a combination of these head positions.

Symptoms

Symptoms of congenital torticollis include limited range of neck motion in both rotation and lateral bending. The head is typically tilted in lateral bending toward the affected sternocleidomastoid muscle and rotated toward the opposite side.

Initial symptoms of spasmodic torticollis are usually mild. The head may turn or tilt in jerky movements or sustain a prolonged position involuntarily. Involuntary spasm of the neck muscles increase in frequency and strength over time. Symptoms can worsen during activity or periods of increased stress.

Other symptoms include muscle hypertrophy (enlargement), neck pain and tremor.

Causes

Congenital torticollis may be caused through birth trauma or intrauterine malposition, which can damage a newborn’s neck muscles, resulting in a shortening or excessive contraction of the sternocleidomastoid muscle, often with limited range of motion in both rotation and lateral bending.

Acquired torticollis occurs because of another problem and usually presents in previously normal children and adults. Some causes include:
  • Trauma to the neck, which can cause the two vertebrae closest to the skull to slide and tear stabilizing ligaments;
  • Skull-base tumors, which can compress the nerve that conducts signals to the neck;
  • Infections, which can irritate the nerves that innervate the neck muscles;
  • Ear infections and surgical removal of the adenoids;
  • The use of some drugs, such as antipsychotics;
  • Sleeping in an awkward position.
Causes are primary (idiopathic) or secondary (symptomatic). Primary spasmodic torticollis is defined a having no other abnormality other than dystonic movement and occasional tremor in the neck. This type of spasmodic torticollis is usually inherited. When other conditions lead to spasmodic torticollis, it is considered a secondary symptom.

Diagnosis

Evaluation of a child with torticollis begins with the recording of a medical history to determine circumstances of birth and potential trauma or associated other symptoms. Diagnosis also includes a physical examination to identify decreased rotation and bending to the side opposite from the affected muscle.

A thorough diagnosis includes a neurologic examination to investigate potential associated conditions. Tests may include radiographs of the cervical spine, and magnetic resonance imaging (MRI) to identify bone abnormalities or structural deficits.

Patient cases of spasmodic torticollis are commonly identified with the Toronto Western Spasmodic Torticollis Rating Scale, which assigns values to severity, disability and pain.

Spasmodic torticollis is diagnosed as a secondary condition when additional neurological or other abnormalities (other than dystonia) are identified during brain imaging.

Related Treatments

  • CT Guided Nerve Block
  • Disability Evaluations
  • Electrodiagnostic Medicine
  • Musculoskeletal Medicine
  • Pain Management
  • Physical Therapy (PT)/Occupational Therapy (OT)/Sp
  • Prosthetics and Orthotics
  • Rehabilitation Counseling
  • Rehabilitation Psychology/Psychotherapy
  • Spasticity Management