Dominic Stone
Torticollis, also known as wry neck or twisted neck, is a condition where the neck muscles cause the head to twist or tilt to one side. It can be congenital or acquired. While the exact cause of torticollis is not known, it is believed to be caused by intrauterine positioning, genetic mutations, or trauma during birth. Acquired torticollis may be caused by an injury, viral infection, inflammation of the neck muscles, or a brain tumor. The condition is characterized by involuntary muscle contractions in the neck, resulting in decreased range of motion, pain, and problems with postural control. Treatment options include physical therapy, stretching exercises, oral medication, and in some cases, surgery. While there is no cure for cervical dystonia, a form of torticollis, injecting botulinum toxin into the affected muscles can reduce symptoms.
| Characteristics | Values |
|---|---|
| Common Name | Wry neck or twisted neck |
| Medical Definition | A condition in which a person's head tilts to one side |
| Muscle Involvement | Sternocleidomastoid, splenius, trapezius, scapula, scalenes, platysma |
| Types | Congenital, Acquired, Adult-onset Idiopathic, Cervical Dystonia, Spasmodic |
| Causes | Genetic, Trauma during birth, Klippel-Feil syndrome, Hematoma, Fibrosis, Viral Infection, Inflammation of Neck Muscles, Brain Tumor, Gastroesophageal reflux (GERD), Vision Problems, Reaction to Medication, Scar Tissue, Arthritis of the Neck, Sandifer Syndrome, Grisel's Syndrome |
| Symptoms | Stiff Neck, Swollen Neck, Small Pea-sized Lump in Neck Muscle, Uneven Facial Features, Limited Head Movement, Head Tremors, Severe Neck Pain |
| Treatment | Physical Therapy, Stretching Exercises, "Tummy Time", Collar for Head and Neck Support, Botulinum Toxin Injection, Surgery |
| Diagnosis | Physical Examination, Ultrasound, X-ray, CT Scan, MRI, Lab Studies |
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What You'll Learn
Torticollis symptoms
Torticollis, also known as wry neck or twisted neck, is a condition in which a person's head tilts to one side. It is characterised by involuntary muscle contractions in the neck musculature, causing the head to turn and rotate to one side. The condition can be congenital or acquired. Congenital torticollis is present at birth or during the neonatal period, while acquired torticollis presents later in life, usually during the first four to six months of a baby's life.
Symptoms of Congenital Torticollis
Congenital torticollis may be caused by trauma during gestation or birth, resulting in edema and fibrosis of the sternocleidomastoid muscle. This leads to a shortening of the muscle fibres, causing the baby's head to tilt to one side. Symptoms of congenital torticollis include:
- Stiff and swollen neck muscles
- Limited range of motion in the neck
- Flattened spot on the baby's head or face due to consistent head positioning during sleep
Symptoms of Acquired Torticollis
Acquired torticollis can have various causes, including injury, viral infection, inflammation of neck muscles, gastroesophageal reflux (GERD), vision problems, medication side effects, scar tissue, and arthritis of the neck (cervical spondylosis). Symptoms of acquired torticollis include:
- Head tilting to one side, with the chin tilted to the other side
- Limited movement of the head and neck
- Uneven facial features, with one shoulder higher than the other
- Neck muscle tightness, stiffness, and swelling
- Severe neck pain
- Head tremors
- Vomiting, pallor, irritability, ataxia, or drowsiness
Diagnosis and Treatment
Doctors can diagnose torticollis through a patient's medical history, physical examination, and diagnostic tests such as X-rays, CT scans, and MRIs. Treatment for torticollis depends on the cause and may include physical therapy, stretching exercises, "tummy time" for babies, and the use of a collar to maintain a neutral head and neck position.
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Torticollis causes
Torticollis, also known as wry neck or twisted neck, is a condition in which a person's head tilts to one side. It can be congenital or acquired. The cause of torticollis depends on the type.
Congenital Torticollis
Congenital torticollis is present at birth or during the neonatal period. It is caused by the shortening of one of the baby's two large sternocleidomastoid muscles (SCMs) in the neck. While researchers are unsure why this happens in some babies, it is thought that intrauterine positioning can lead the head to be twisted in utero. If the fetus remains in this position for a prolonged period, there can be a localized compartment syndrome phenomenon leading to ischemia (reduced or blocked blood flow/oxygen) that creates fibrosis in the SCM. Other possible causes include an abnormal development in the SCM, a collection of blood in the baby's neck muscles (hematoma), abnormal thickening of the baby's muscle tissue (fibrosis), or Klippel-Feil syndrome, a rare birth defect that causes the vertebrae in the neck to fuse.
Acquired Torticollis
Acquired torticollis usually occurs in the first four to six months of a baby's life or later. It may be harmless (benign) or a sign of a more serious health issue. It frequently occurs due to swelling in the child's throat, causing the tissues surrounding the upper spine to loosen and allowing the vertebrae to move out of their normal position. Other causes of acquired torticollis include gastroesophageal reflux (GERD), vision problems, reaction to certain medications, scar tissue, arthritis of the neck (cervical spondylosis), and Sandifer syndrome, a rare condition that combines GERD with neck spasms. In rare cases, a brain tumor can cause acquired torticollis.
Cervical Dystonia
Cervical dystonia, also called spasmodic torticollis, is a painful condition in which the neck muscles contract involuntarily, causing the head to twist or turn to one side, tilt forward, or tilt backward. It can occur at any age but is most common in middle-aged people, especially women. It is often caused by dysfunctions in the local neuromuscular mechanisms (focal dystonia) and can sometimes be a symptom of more complex and serious diseases. In some cases, the involuntary muscle contractions associated with cervical dystonia can spread to nearby areas of the body, including the face, jaw, arms, and trunk.
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Torticollis diagnosis
Torticollis, also known as wry neck or twisted neck, is a condition in which a person's head tilts to one side. It is relatively common in children and can be congenital or acquired. The cause of torticollis is not completely known, but it is believed to be related to intrauterine positioning, genetic mutations, or, in rare cases, a brain tumour.
To diagnose torticollis, doctors will first take a detailed medical history and perform a physical examination. They will look at the patient's range of motion in the head and neck and check for any swelling or stiffness in the neck muscles. In babies, doctors will physically examine the baby's head and neck, looking for a small, palpable, painless lump on the neck muscle. They will also measure the baby's range of neck motion and look for a flattened spot on the baby's head or face, which can occur when the baby sleeps with their head turned in the same direction.
Diagnostic tests for torticollis may include radiography (X-ray), computed tomography (CT scan), ultrasound imaging, and laboratory analysis of blood to screen for metabolic or genetic factors. These tests can help identify any damage to tissue or neck vertebrae, as well as check for strabismus, nystagmus, signs of intracranial hypertension, or other focal neurological signs.
In cases of spasmodic torticollis, which is more common in adults, the pain is unilateral and can radiate to the shoulder, and there is muscle stiffness. Cervical dystonia, a type of spasmodic torticollis, causes involuntary contractions of the neck muscles, leading to head tilting and turning. It can also cause bone spurs that reduce space in the spinal canal, resulting in tingling, numbness, and weakness in the limbs.
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Torticollis treatment
Torticollis, sometimes called wry neck or twisted neck, is a rare condition that causes involuntary head tilting, often due to tightened neck muscles. It can be congenital or acquired. Treatment for torticollis depends on the type and cause of the condition.
Congenital Torticollis Treatment
Congenital torticollis is present at birth or during the neonatal period. It is often due to positioning in the womb or complications during birth that affect muscle development in the neck. Treatment for congenital torticollis typically includes simple position changes or stretching exercises done at home. Doctors can show parents how to perform these exercises, which aim to stretch out the tight neck muscle so that the baby's head rests in a neutral position rather than at an angle. One such exercise is "tummy time," where a baby is placed on their stomach to strengthen their neck muscles. This exercise can also help treat flat head syndrome, which can occur when a baby frequently lies with their head turned in the same direction. In rare cases, surgery may be needed to lengthen the tight neck muscle or correct a vertebral problem.
Acquired Torticollis Treatment
Acquired torticollis usually occurs in the first four to six months of a baby's life or later. It is typically caused by an injury, viral infection, or inflammation of the neck muscles. Treatment for acquired torticollis may include non-steroidal anti-inflammatory drugs (NSAIDs) and a neck collar to help reduce pain and muscle activity. Physical therapy can also be beneficial, including stretching and strengthening exercises to improve flexibility and range of motion. In some cases, botulinum toxin (Botox) injections may be used to relax the tight neck muscle.
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Torticollis complications
Torticollis, also known as twisted neck or wry neck, is a rare condition that causes involuntary head tilting due to tightened neck muscles or another underlying condition. While torticollis is not a standalone diagnosis, it is a symptom of various underlying conditions, which can be congenital or acquired. The congenital form typically appears within weeks after birth and is often isolated.
There are several complications associated with torticollis, and they vary depending on the type of torticollis and the age of the affected individual. Here are some common complications:
Complications in Infants and Children
- Craniofacial asymmetry: Untreated or inadequately managed torticollis can lead to craniofacial asymmetry, where the face and chin are rotated to one side, causing an uneven appearance.
- Functional impairment: If left untreated, torticollis can lead to functional impairment, affecting the child's ability to perform daily activities.
- Long-term musculoskeletal abnormalities: Without proper management, torticollis can result in long-term musculoskeletal issues, impacting the child's posture and movement.
- Flat head syndrome: Also known as plagiocephaly, this condition can occur when an infant frequently lies down with their head turned in the same direction. Physical therapy and "tummy time" exercises can help prevent this complication.
- Numbness and tingling: If torticollis becomes chronic, neck nerve pressure can cause numbness and tingling sensations in the affected area.
Complications in Adults
- Cervical dystonia: Also known as spasmodic torticollis, this is a type of torticollis that typically affects adults. It is characterized by involuntary muscle contractions, causing the head to twist or turn to one side. It can also lead to forward or backward head tilting.
- Bone spurs: In some cases of cervical dystonia, bone spurs may develop, reducing the space in the spinal canal. This can result in tingling, numbness, and weakness in the arms, hands, legs, or feet.
- Nerve damage: Untreated torticollis in adults can lead to nerve damage in the neck area, causing chronic pain and discomfort.
- Cosmetic concerns: Adults with torticollis may seek treatment for cosmetic reasons, as the condition can affect the appearance of the head and neck position.
It is important to note that early diagnosis and treatment of torticollis can help prevent or minimize the impact of these complications. Treatment options may include physical therapy, stretching exercises, medication, or, in some cases, surgery.
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Frequently asked questions
Torticollis, also known as wry neck or twisted neck, is a condition in which a person's head tilts to one side. It can be congenital or acquired.
Symptoms of torticollis include stiff and swollen neck muscles, involuntary muscle contractions, and limited movement of the head and neck. One of the baby's shoulders may be higher than the other, and they may also experience severe neck pain and head tremors.
The exact cause of torticollis is not always known, but it is believed to be related to intrauterine positioning, genetic mutations, injury, viral infection, or inflammation of the neck muscles. In rare cases, it can be caused by a brain tumour.
Torticollis can cause decreased range of motion, pain, and problems with postural control. It is characterised by involuntary muscle contractions in the neck, which can result in considerable somatic and psychological disability. However, it is not clear if torticollis directly causes low muscle tone.
