Dominic Stone
Torticollis, also known as wry neck, is a rare condition that causes the neck to painfully twist and tilt to one side. It is often caused by tightened neck muscles, but can also be due to other underlying conditions. While the cause of torticollis is typically muscular, it can also be congenital, related to trauma, illness, or injury, or even a side effect of medication. In rare cases, it can be caused by a brain injury or tumour. The condition is most often treated with pain relief, gentle heat, and massage, and symptoms usually disappear within a week.
| Characteristics | Values |
|---|---|
| Definition | Torticollis, also known as wry neck or twisted neck, is a rare condition that causes involuntary head tilting, frequently due to tightened neck muscles or another underlying condition. |
| Causes | Trauma, illness, or another cause that affects the flexibility or tone of the dominant muscle on one side of the neck. Congenital torticollis can be caused by the positioning of the baby in the womb, abnormal development in the SCM, a collection of blood in the baby's neck muscles, or abnormal thickening of muscle tissue. Acquired torticollis may be caused by an injury, viral infection, inflammation of neck muscles, or certain medications. |
| Symptoms | Neck muscle spasms, pain on one side of the neck, stiffness, swelling, and limited range of motion. |
| Treatment | Pain relief, gentle heat, massage, stretching exercises, physical therapy, medication, and in some cases, surgery. |
| Prevention | Keeping active, moving the neck normally, improving posture, and taking frequent breaks. |
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What You'll Learn
Trauma to the neck or spine
Torticollis can be congenital, present at birth or during the neonatal period, or acquired later in life. In infants, trauma during gestation or childbirth can cause oedema in the muscle, leading to congenital fibrosis of the sternocleidomastoid muscle and subsequent shortening of its fibres. This results in a limitation of movement and can be observed in cases of burns or scars.
In adults, trauma to the neck or spine can cause torticollis as a result of injuries to the cervical spine or neck muscles. This can occur from minor injuries or awkward sleeping positions that may be difficult to recall. In adults, torticollis can also be caused by adverse reactions to medications.
To treat torticollis, it is recommended to stay active and move the neck as normally as possible. Physical therapy is often a primary treatment option, with stretching and strength exercises prescribed. In severe cases, surgery may be required, and a doctor may refer the patient to an orthopedic surgeon or a specialist in brain-stimulation techniques.
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Muscle spasms
Torticollis is often a muscular problem, with the most common type being fixed torticollis, which results from scarring or tight muscles on one side of the neck. This tightening of the neck muscles can be caused by various factors, including trauma or injury to the neck or spine, leading to spasms and the characteristic twisting of the head. In some cases, torticollis may be related to complex or serious diseases, such as brain injury or tumours, or it may be congenital, present at birth or during the neonatal period.
The primary muscles involved in torticollis include the sternocleidomastoid, splenius, trapezius, scapula, scalenes, and platysma. The sternocleidomastoid muscle is the most commonly affected, and its shortening can cause congenital torticollis. This shortening may be due to various factors, such as the positioning of the baby in the womb, abnormal development, or fibrosis.
Treatment for torticollis typically involves pain relief, gentle heat, and massage. In some cases, stretching exercises and posture improvements may be recommended to help relieve symptoms and prevent stiffness. Early treatment is crucial for successful outcomes, and in severe cases, surgery may be considered.
While the exact cause of torticollis is not always known, it is believed that intrauterine positioning can lead to a twisted head position in utero, resulting in reduced blood flow and oxygen, which creates fibrosis in the sternocleidomastoid muscle. Genetic mutations can also increase the risk of congenital torticollis, and certain medications, drug abuse, and neurological conditions can contribute to the development of the condition.
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Congenital causes
Congenital torticollis is present at birth or during the neonatal period. It is a condition in which an infant holds its head tilted to one side and has difficulty turning it to the opposite side. The specific cause of congenital torticollis is still being researched, but it is thought to be related to the positioning of the baby in the womb or a difficult birth, especially if the infant is delivered in the breech position.
The condition occurs when the sternocleidomastoid muscle, which runs from the jawbone to the clavicle and sternum, is strained, causing it to shorten and tighten. This results in the infant's head being pulled to one side. The injured muscle may also develop fibrosis (scar tissue), which can further restrict movement. In some cases, the fibrosis forms a mass or lump that can be felt on the side of the neck.
Congenital torticollis may be visible at birth, or it may not become apparent until several weeks after birth. It is typically diagnosed through a physical examination, which may include checking for a characteristic head tilt, muscle tightness, and the presence of a lump in the affected muscle. In some cases, imaging tests such as X-rays or ultrasounds may be used to rule out other medical conditions.
The standard treatment for congenital torticollis consists of gentle stretching exercises and positioning techniques to help loosen and stretch the affected muscle. These exercises are typically taught by a physical therapist and must be performed several times a day. Parents can also encourage their babies to turn their heads by strategically placing toys or holding them in a way that requires them to look in a certain direction.
It is important to address congenital torticollis early on, as leaving it untreated can lead to permanent muscle tightening and uneven development of the neck and face.
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Treatment options
Conservative Management
Conservative management involves exploring and addressing any underlying reversible causes of torticollis. This may include treating infections, addressing posture issues, or discontinuing medications that may be causing the condition.
Medications
Medications can play a crucial role in managing torticollis. Topical or oral anti-inflammatory drugs, muscle relaxants, anti-spasmodics, and anticholinergics can help reduce muscle spasms and inflammation. Benzodiazepines may also be prescribed to help relieve associated symptoms.
Physical Therapy
Physical therapy is an essential component of treatment. It includes stretching exercises, massage, local heat application, and sensory biofeedback techniques to reduce muscle tension, improve range of motion, and relieve pain. Physiotherapists can also provide guidance on improving posture and making ergonomic adjustments to prevent future occurrences.
Injections
In some cases, local intramuscular injections of botulinum toxin (Botox) may be recommended. These injections help relax the contracted muscles, correct head positioning, and relieve pain. Botox injections are typically considered when other conservative measures have not provided sufficient improvement.
Surgical Intervention
Surgery is generally a last resort and is reserved for cases where other treatments have failed to provide relief. Surgical procedures may include sternocleidomastoid release (unipolar or bipolar), selective denervation, or dorsal cord stimulation. The type of surgical approach depends on the severity and specific characteristics of the patient's condition.
Interprofessional Collaboration
An interprofessional team approach involving physicians, mid-level practitioners, nurses, pharmacists, physical therapists, and chiropractors can often achieve the best outcomes for patients with torticollis. This collaborative care ensures that all aspects of the condition are addressed, including physical, mental, and pharmaceutical needs.
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Prevention
Although there is no guaranteed way to prevent torticollis, there are some measures that can be taken to reduce the risk of developing the condition.
Torticollis, or wry neck, is a condition where the neck muscles spasm, causing pain on one side and difficulty straightening the neck. It can be congenital, caused by trauma, or develop from minor muscle trauma. It can also be caused by inflammation in the neck or nearby muscles and ligaments, or adverse reactions to certain medications.
To prevent torticollis, one should try to maintain good posture, especially when sitting for long periods. It is important to stand and sit straight, with shoulders over hips and ears over shoulders. When using phones or tablets, hold them up to eye level instead of bending the neck down. When working at a desk, use a footrest if your knees and hips are not level, and move regularly used items closer to you so you don't have to twist or reach too far. Take frequent breaks, especially if you work at a computer or travel long distances, and stretch your neck and shoulders.
For infants, it is important to encourage them to turn their heads in both directions to loosen tense neck muscles and tighten loose ones. This can be done by offering the bottle or breast in a way that encourages the baby to turn away from their favoured side. When putting the baby down to sleep, position them facing away from you so they will actively turn their head. During play, encourage the baby to turn their head by drawing their attention with toys and sounds. Laying the baby on their stomach for short periods while awake, known as "tummy time", is also an effective exercise.
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Frequently asked questions
Torticollis, sometimes called wry neck or twisted neck, is a rare condition that causes involuntary head tilting, frequently due to tightened neck muscles or another underlying condition.
Yes, a torn or damaged muscle can cause torticollis. Torticollis is often a muscular problem that can be easily corrected. It can be caused by a minor injury or trauma to a muscle that you might not even remember, such as sleeping in an awkward position.
The symptoms of torticollis include stiff and swollen neck muscles, limited movement of the head and neck, and pain on one side of the neck. The neck tends to twist to one side, causing a head tilt.
Treatments for torticollis include pain relief, applying gentle heat and massage, and gentle muscle stretches and position changes.
