Torticollis

Definition:

Torticollis is a form of dystonia (prolonged muscle contractions) in which the neck muscles contract involuntarily causing the head to turn.

Alternative Names:

Wry neck; Loxia

Causes, incidence, and risk factors:

The condition may occur without known cause (idiopathic), be genetic (inherited), or be acquired secondary to damage to the nervous system or muscles. It may develop in childhood or adulthood. Congenital torticollis (present at birth) may be caused by malpositioning of the head in the uterus, or by prenatal injury of the muscles or blood supply in the neck.

Symptoms:

Enlargement of the neck muscles (possibly present at birth)
Asymmetry of an infants head from sleeping on the affected side
Shoulder may elevate on the affected side
Stiffness of neck muscles
Limited range of motion
Headache
Neck pain
Head tremor

Signs and tests:

Various tests or procedures may be done to rule out possible causes of head and neck pain. A physical examination will show a visible shortening of the neck muscles and the head will tilt toward the affected side while the chin points to the opposite side.

Treatment:

The treatment aim of congenital torticollis is to stretch the shortened neck muscle. Passive stretching and positioning are treatments used in infants and small children. Surgical sectioning of the neck muscle may be done in the preschool years, if other treatment methods fail.

Acquired torticollis is treated by identifying the underlying cause of the disorder. Application of heat, traction to the cervical spine, and massage may help relieve head and neck pain. Stretching exercises and neck braces may help with muscle spasms.

Drug treatments include anticholinergic drugs (baclofen). Injection of botulinum toxin is very effective to relieve the torticollis temporarily, but repeat injections every three months are usually required. Surgical treatments are rarely used.

Expectations (prognosis):

The condition may be easier to correct in infants and children. If the condition becomes chronic, numbness and tingling sensations may develop as nerve roots become compressed in the cervical spine. Botulinum toxin injections often provide substantial relief.

Complications:

Some complications include neurological symptoms from compressed nerve roots.

Calling your health care provider:

Call for an appointment with your health care provider if symptoms do not improve with treatment, or if new symptoms develop.

Prevention:

There is no known prevention, however, early treatment may prevent a worsening of the condition.

Review Date: 7/20/2001
Reviewed By: Galit Kleiner-Fisman, M.D., FRCP(C), Department of Neurology, University of Toronto, Toronto, Ontario, Canada. Review provided by VeriMed Healthcare Network.

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